Vision screening using a smartphone platform.

OBJECTIVE: The main aim of this study was to evaluate the performance of a platform designed for pediatricians to screen amblyopia using a smartphone. METHODS: The medical records of consecutive children who received visual screening using a smartphone platform were retrospectively reviewed. The smartphone was used with a flash concentrator case and a software for capturing images of both eyes simultaneously by a photorefraction mechanism. The platform performance was compared to the comprehensive ophthalmological examination, which is considered the gold standard for detecting amblyopia. Sensitivity, specificity, positive predictive value, and negative predictive value of the software in detecting amblyopia risk factors were calculated. RESULTS: A total of 157 children were included, with a mean age of 6.0±.5 years (range 5-7). In 94% of the cases, the software was able to analyze the images and release a result, determining whether or not the child presented with amblyopia risk factors. Compared to the ophthalmological examination, the smartphone platform sensitivity in detecting amblyopia risk factors was 84%, the specificity was 74%, the positive predictive value was 86%, and the negative predictive value was 70%. CONCLUSIONS: The sensitivity and specificity of the smartphone photoscreening platform to detect amblyopia risk factors were within the range of traditional instrument-based vision screening technology. A smartphone photorefraction platform appears to be a promising cost-effective alternative to assist pediatricians and minimize obstacles to vision screening and amblyopia detection. Future studies are needed to gather additional comparative data.

Vision screening using a smartphone platform / Triagem visual usando uma plataforma no smartphone

ABSTRACT Objective: The main aim of this study was to evaluate the performance of a platform designed for pediatricians to screen amblyopia using a smartphone. Methods: The medical records of consecutive children who received visual screening using a smartphone platform were retrospectively reviewed. The smartphone was used with a flash concentrator case and a software for capturing images of both eyes simultaneously by a photorefraction mechanism. The platform performance was compared to the comprehensive ophthalmological examination, which is considered the gold standard for detecting amblyopia. Sensitivity, specificity, positive predictive value, and negative predictive value of the software in detecting amblyopia risk factors were calculated. Results: A total of 157 children were included, with a mean age of 6.0±.5 years (range 5-7). In 94% of the cases, the software was able to analyze the images and release a result, determining whether or not the child presented with amblyopia risk factors. Compared to the ophthalmological examination, the smartphone platform sensitivity in detecting amblyopia risk factors was 84%, the specificity was 74%, the positive predictive value was 86%, and the negative predictive value was 70%. Conclusions: The sensitivity and specificity of the smartphone photoscreening platform to detect amblyopia risk factors were within the range of traditional instrument-based vision screening technology. A smartphone photorefraction platform appears to be a promising cost-effective alternative to assist pediatricians and minimize obstacles to vision screening and amblyopia detection. Future studies are needed to gather additional comparative data.

RESUMO Objetivo: Avaliar a performance de uma plataforma desenvolvida para pediatras para triagem de ambliopia utilizando um smartphone. Métodos: Os prontuários consecutivos de crianças submetidas a triagem visual usando uma plataforma no smartphone foram analisados retrospectivamente. Uma capa concentradora de flash foi utilizada no smartphone com um software para capturar imagens simultâneas dos dois olhos por um mecanismo de fotorrefração. A performance da plataforma foi comparada ao exame oftalmológico completo, considerado o padrão ouro para detecção de ambliopia. Foram calculados sensibilidade, especificidade, valor preditivo positivo e valor preditivo negativo do software em detectar fatores de risco para ambliopia. Resultados: Foram incluídas 157 crianças com idade média de 6.0±0.5 anos (variação de 5 a 7 anos). Em 94% dos casos, o software foi capaz de analisar as imagens e fornecer um resultado, determinando se a criança apresentava ou não fatores de risco para ambliopia. Comparados ao exame oftalmológico, a sensibilidade da plataforma no smartphone em detectar fatores de risco para ambliopia foi de 84%, a especificidade foi de 74%, o valor preditivo positivo foi de 86% e o valor preditivo negativo foi de 70%. Conclusões: A plataforma de triagem por fotorrefração usando o smartphone apresentou sensibilidade e especificidade para detectar fatores de risco para ambliopia semelhantes às encontradas em instrumentos tradicionais de triagem por fotorrefração. Uma plataforma no smartphone é uma alternativa custo-efetiva promissora para auxiliar pediatras a minimizar os obstáculos para triagem visual e detecção da ambliopia. Estudos futuros são necessários a fim de reunir dados comparativos adicionais.

Vision for the Future Project: Screening impact on the prevention and treatment of visual impairments in public school children in São Paulo City, Brazil.

OBJECTIVES: Uncorrected refractive errors are the leading cause of visual impairment in children. In this cross-sectional retrospective study, we analyzed a social visual screening program for school children in São Paulo, Brazil, evaluated its impact on the prevention and treatment of children's visual disabilities, and assessed its epidemiological outcomes to outline suggestions for its improvement. METHODS: First-grade children from public schools were submitted to prior visual screening by their teachers. Selected children were forwarded to the hospital's campaigns for a second screening by ophthalmologists and treatment if needed. Data were analyzed for age, sex, visual acuity, biomicroscopy, refractive errors, ocular movement disorders, amblyopia, number of donated spectacles, and number of children forwarded to specialized care. RESULTS: A total of 1080 children were included with mean age of 6.24±0.45 years. Children with normal ophthalmological exam, 591 (54.7%; 95% confidence interval [CI]: 51.7%-57.7%) were dismissed and considered false-positives. Myopia, hyperopia, and astigmatism components were found in 164 (15.2%; CI: 13.1%-17.4%), 190 (17.6%; CI: 15.3%-20.0%), and 330 (30.5%; CI: 27.8%-33.4%) children, respectively. Amblyopia was diagnosed in 54 (5%; CI: 3.5%-6.4%) children, and 117 (10.8%; CI: 9.8%-12.8%) presented ocular movement disorders. A total of 420 glasses were donated. CONCLUSION: Epidemiological findings for amblyopia and refractive errors are consistent with those of similar studies. The expressive number of diagnoses performed and number of glasses donated to underprivileged children depict the importance of such projects. New guidelines to improve their cost-effectiveness, such as professional training and community sensitization, are imperative.

The action of subconjunctival cyclophosphamide in rabbits / Ação da ciclofosfamida subconjuntival em coelhos

ABSTRACT Objective: To observe clinically, in rabbits, the side effects of topical injection of subconjunctival cyclophosphamide, studying its role as an antifibrotic drug. Methods: Prospective study in 20 albino rabbits of New Zealand race. All rabbits were treated with cyclophosphamide, 10mg/ml in a volume of 0.3 ml, in the left eye through subconjunctival injection. They were evaluated for 1, 7, 30, and 60 days after the procedure. All the animals were examined for the detection of ocular reactions such as necrosis, hyperemia, chemosis, secretion, opacity, and iritis. Other side effects as changes in the behavior, in the feed, and the water consumption were also evaluated. Results: It was observed that from the 20 rabbits studied, three rabbits (15%) showed side effects only at the 24 hours analysis. One rabbit (5%) presented hyperemia, one rabbit (5%) had hyperemia associated with iritis, and one rabbit (5%) presented hyperemia associated with secretion. These reactions were not observed at 1, 7, 30, and 60 days. Conclusion: Cyclophosphamide subconjunctival injection induces minor side effects on the conjunctiva of rabbits such as hyperemia, associated with iritis and secretion.

RESUMO Objetivo: Observar clinicamente os efeitos colaterais de injeção subconjuntival de ciclofosfamida, pensando em sua ação como um agente antifibrótico. Métodos: Estudo prospectivo realizado com 20 coelhos albinos da raça Nova Zelândia. Todos os coelhos foram submetidos a 0,3 ml de injeção subconjuntival de ciclofosfamida 10mg/ml no olho esquerdo e foram avaliados de acordo com os efeitos locais no primeiro dia após a injeção, 7, 30 e 60 dias. Foram examinados para detecção de reações oculares como necrose, hiperemia, quemose, secreção, opacidade corneana, irite além de alterações comportamentais e variação no consumo de água e alimentação. Resultados: Dos 20 coelhos estudados, apenas 3 apresentaram reações oculares e somente na leitura de 24 horas. Um coelho (5%) apresentou hiperemia, 1 coelho (5%) apresentou hiperemia associada a presença de irite e 1 coelho (5%) apresentou hiperemia associada a presença de secreção. As reações não foram mais observadas durante os exames de 7, 30 e 60 dias. Conclusão: A ciclofosfamida subconjuntival causou poucos efeitos colaterais na conjuntiva dos coelhos. Os únicos efeitos encontrados foram hiperemia, irite e secreção.

Estudo comparativo da inibição da proliferação de fibroblastos in vitro na conjuntiva utilizando mitomicina C e ciclofosfamida / Comparative study of inhibition of fibroblasts proliferation in vitro in the conjunctiva using mitomycin and ciclophosphamide

RESUMO Objetivo: Avaliar a inibição da proliferação de fibroblastos in vitro das conjuntivas obtidas através de exérese de pterígios de pacientes utilizando mitomicina C (MMC) e ciclofosfamida (CF). Métodos: Os pterígios foram retirados de 7 pacientes e submetidos a cultivo celular. Após o cultivo, 3 fragmentos de dimensões iguais deste material foram colhidos de áreas adjacentes do pterígio removido de cada paciente. Eles foram randomicamente selecionados de tal forma que: um fragmento de cada paciente foi exposto: ao meio de cultura (grupo controle), a MMC e a CF por igual período de tempo nas concentrações de 0,4 mg/ml e 10 mg/ml respectivamente. Após este período realizou-se a contagem celular de fibroblastos destes 3 grupos. Cada grupo continha 7 fragmentos. Resultados: Com a utilização da MMC tivemos uma taxa de 95% da inibição da proliferação dos fibroblastos, enquanto com a CF 100%. Conclusões: Ambas as drogas apresentaram elevada taxa da inibição da proliferação de fibroblastos, porém a CF apresentou inibição maior que a MMC.

Abstract Objective: To evaluate the inhibition of fibroblast proliferation in vitro of conjunctiva obtained by excision of pterygium from patients using mitomycin (MMC) and cyclophosphamide (CF). Methods: Pterygiums were removed from 7 patients and subjected to cell culture. After cell cultivation, 3 fragments of equal dimensions of these tissues were collected from adjacent areas of each patient removed pterygium. They were randomly selected in such a way that one fragment of each patient was exposed to: the culture medium (group control), to MMC and to CF for an equal period of time at concentrations of 0,4 mg/dl and 10 mg/dl respectively. After this period, the fibroblast cell count of these groups were performed. Each group had seven fragments. Results: With the use of MMC we had a 95% rate of inhibition of fibroblast proliferation, while with CF 100%. Conclusion: Both drugs showed a high rate of inhibition of fibroblast proliferation, but CF showed greater inhibition than MMC.

Vision for the Future Project: Screening impact on the prevention and treatment of visual impairments in public school children in São Paulo City, Brazil

OBJECTIVES: Uncorrected refractive errors are the leading cause of visual impairment in children. In this cross-sectional retrospective study, we analyzed a social visual screening program for school children in São Paulo, Brazil, evaluated its impact on the prevention and treatment of children's visual disabilities, and assessed its epidemiological outcomes to outline suggestions for its improvement. METHODS: First-grade children from public schools were submitted to prior visual screening by their teachers. Selected children were forwarded to the hospital's campaigns for a second screening by ophthalmologists and treatment if needed. Data were analyzed for age, sex, visual acuity, biomicroscopy, refractive errors, ocular movement disorders, amblyopia, number of donated spectacles, and number of children forwarded to specialized care. RESULTS: A total of 1080 children were included with mean age of 6.24±0.45 years. Children with normal ophthalmological exam, 591 (54.7%; 95% confidence interval [CI]: 51.7%-57.7%) were dismissed and considered false-positives. Myopia, hyperopia, and astigmatism components were found in 164 (15.2%; CI: 13.1%-17.4%), 190 (17.6%; CI: 15.3%-20.0%), and 330 (30.5%; CI: 27.8%-33.4%) children, respectively. Amblyopia was diagnosed in 54 (5%; CI: 3.5%-6.4%) children, and 117 (10.8%; CI: 9.8%-12.8%) presented ocular movement disorders. A total of 420 glasses were donated. CONCLUSION: Epidemiological findings for amblyopia and refractive errors are consistent with those of similar studies. The expressive number of diagnoses performed and number of glasses donated to underprivileged children depict the importance of such projects. New guidelines to improve their cost-effectiveness, such as professional training and community sensitization, are imperative.

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

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

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

Rho kinase inhibitors for glaucoma treatment - Review.

Glaucoma is a progressive optic neuropathy characterized by the loss of ganglion cells and their axons. A major risk factor for glaucomatous visual field loss is elevated intraocular pressure (IOP), and several studies have shown that lowering IOP reduces the risk of glaucomatous progression. Currently, an increasing number of researches involve Rho kinase inhibitors, which are a new pharmacological class of hypotensive agents specifically targeting the diseased trabecular outflow pathway. Rho kinase inhibitors reduce IOP by increasing aqueous humor drainage through the primary outflow pathway in the eye, which is known as the trabecular meshwork. In addition to improving the outflow facility of the trabecular meshwork, Rho kinase inhibitors also enhance retinal ganglion cell survival after ischemic injury and increase ocular blood flow.

Rho kinase inhibitors for glaucoma treatment - Review / Inibidores da Rho-Quinase para o tratamento do glaucoma - Revisão

ABSTRACT Glaucoma is a progressive optic neuropathy characterized by the loss of ganglion cells and their axons. A major risk factor for glaucomatous visual field loss is elevated intraocular pressure (IOP), and several studies have shown that lowering IOP reduces the risk of glaucomatous progression. Currently, an increasing number of researches involve Rho kinase inhibitors, which are a new pharmacological class of hypotensive agents specifically targeting the diseased trabecular outflow pathway. Rho kinase inhibitors reduce IOP by increasing aqueous humor drainage through the primary outflow pathway in the eye, which is known as the trabecular meshwork. In addition to improving the outflow facility of the trabecular meshwork, Rho kinase inhibitors also enhance retinal ganglion cell survival after ischemic injury and increase ocular blood flow.

RESUMO Glaucoma é uma neuropatia óptica progressiva, caracterizada pela perda de células ganglionares e seus axônios. O principal fator de risco que leva à perda de campo visual relacionada ao glaucoma é a elevação da pressão intraocular (PIO) e vários estudos mostraram que a redução da pressão intraocular diminui o risco de progressão do glaucoma. Atualmente, uma nova classe de drogas hipotensoras foi desenvolvida e tem sido cada vez mais estudada, os inibidores da Rho-Kinase. Essas drogas reduzem a pressão intraocular aumentando a drenagem de humor aquoso através da via de drenagem primária do humor aquoso no olho, a malha trabecular. Além de aumentar o escoamento pela malha trabecular, inibidores da Rho-kinase também aumentam a sobrevivência das células ganglionares retinianas após isquemia e aumentam o fluxo ocular sanguíneo.

Twenty-four-hour repeatability of diurnal intraocular pressure patterns in glaucomatous and ocular hypertensive individuals.

OBJECTIVE: To verify the 24-hour repeatability of diurnal intraocular pressure patterns in glaucomatous and ocular hypertensive individuals. METHODS: A prospective analysis of 88 eyes from 88 ocular hypertensive or open-angle glaucoma patients was conducted on diurnal tension curves obtained by the same examiner on two consecutive days. The intraclass correlation coefficient test was used for statistical analysis. RESULTS: Eighty-eight eyes from 88 patients were analyzed. Fifty-seven patients (64.8%) were female. The mean age of all participants was 68.7 (SD 10.8, range 51-79) years. The intraclass correlation coefficient values for measurements at 8 AM, 11 AM, 2 PM, and 4 PM were 0.80, 0.82, 0.83, and 0.86, respectively (all intraclass correlation coefficient values, p<0.001). CONCLUSION: Diurnal intraocular pressure data collected on a single day characterize the diurnal intraocular pressure variability over 24 hours in primary open-angle glaucoma and ocular hypertensive patients.

Twenty-four-hour repeatability of diurnal intraocular pressure patterns in glaucomatous and ocular hypertensive individuals

OBJECTIVE: To verify the 24-hour repeatability of diurnal intraocular pressure patterns in glaucomatous and ocular hypertensive individuals. METHODS: A prospective analysis of 88 eyes from 88 ocular hypertensive or open-angle glaucoma patients was conducted on diurnal tension curves obtained by the same examiner on two consecutive days. The intraclass correlation coefficient test was used for statistical analysis. RESULTS: Eighty-eight eyes from 88 patients were analyzed. Fifty-seven patients (64.8 percent) were female. The mean age of all participants was 68.7 (SD 10.8, range 51-79) years. The intraclass correlation coefficient values for measurements at 8 AM, 11 AM, 2 PM, and 4 PM were 0.80, 0.82, 0.83, and 0.86, respectively (all intraclass correlation coefficient values, p<0.001). CONCLUSION: Diurnal intraocular pressure data collected on a single day characterize the diurnal intraocular pressure variability over 24 hours in primary open-angle glaucoma and ocular hypertensive patients.

Correlation between central corneal thickness and intraocular pressure peak and fluctuation during the water drinking test in glaucoma patients.

OBJECTIVE: To investigate the correlation between central corneal thickness and outflow facility assessed by intraocular pressure peak and fluctuation during the water drinking test. METHODS: Fifty-five newly diagnosed primary open-angle glaucoma patients submitted to central corneal thickness measurements and water drinking test were enrolled in this retrospective study.;. Patients were divided into three groups according to their central corneal thickness. Pearson's Correlation test was performed in the groups with lower and higher pachymetric values. RESULTS: The mean age was 65,65 ± 28,28 years; 63,63% were female and 52,72% were caucasian. The mean central corneal thickness was 544,32 ± 36,86 µm, and the mean baseline intraocular pressure was 23,36 ± 6,26 mmHg. During the water drinking test, the mean intraocular pressure peak and mean intraocular pressure fluctuation were 30,43 ± 8,13 mmHg and 31,46 ± 18,46%, respectively. No relevant correlation was detected between the central corneal thickness and the intraocular pressure peak (r² = 0,021) or between the central corneal thickness and the intraocular pressure fluctuation (r² = 0,011). Group 1 presented a mean central corneal thickness of 505,81 ± 13,86 µm, and Group 3 was 583,55 ± 27,87 µm (p = 0,001). The mean intraocular pressure peak was 31,05 ± 9,05 mmHg and 27,83 ± 4,92 mmHg in Group 1 and in Group 3, respectively (p = 0,193). The difference of intraocular pressure fluctuation was not statistically significant between Group 1 (mean 28,47 ± 16,25%) and Group 3 (mean 33,27 ± 21,27%) (p = 0,43). CONCLUSION: In our case series, no correlation was found between central corneal thickness and water drinking test results.

Estresse em pacientes com glaucoma primário de ângulo aberto / Stress in patients with primary open-angle glaucoma

Glaucoma Primário de Ângulo Aberto (GPAA) é uma importante causa de cegueira no mundo. O presente trabalho teve como objetivo investigar: (1) presença e tipo de estresse; (2) relação do número de colírios e estresse; (3) percepção do glaucoma e tratamento. Um estudo transversal e quantitativo foi realizado com 102 pacientes do Ambulatório de Oftalmologia do HC-FMUSP, com roteiro temático e Inventário de Sintomas de Estresse de Lipp. A maioria dos pacientes apresentou estresse (65,7 por cento) e não houve correlação entre estresse e número de colírios. "Tempo de tratamento", "dificuldades na vida diária" e "dificuldades em pingar o colírio" foram variáveis independentemente associadas ao estresse. Conclui-se que o estresse pode interferir negativamente no enfrentamento da doença em pacientes com GPAA.(AU)

Primary Open-Angle Glaucoma (POAG) is an important cause of blindness worldwide. This paper aimed to investigate: (a) the presence and type of stress; (b) the relationship between the number of eye-drops and stress; (c) perceptions regarding glaucoma and its treatment. In a transversal and quantitative study, we assessed 102 patients from the Ophthalmology Clinic of the HC-FMUSP by means of a thematic interview and the Lipp's Stress Symptoms Inventory (LSSI). Most of the patients were stressed (65,7 percent) and there was no correlation between stress and the number of eye-drops. "Time of treatment", "difficulties in daily life" and "difficulties to instillate the drops" were independently associated with stress. In conclusion, stress can negatively interfere in coping with POAG.(AU)

Estresse em pacientes com glaucoma primário de ângulo aberto / Stress in patients with primary open-angle glaucoma

Glaucoma Primário de Ângulo Aberto (GPAA) é uma importante causa de cegueira no mundo. O presente trabalho teve como objetivo investigar: (1) presença e tipo de estresse; (2) relação do número de colírios e estresse; (3) percepção do glaucoma e tratamento. Um estudo transversal e quantitativo foi realizado com 102 pacientes do Ambulatório de Oftalmologia do HC-FMUSP, com roteiro temático e Inventário de Sintomas de Estresse de Lipp. A maioria dos pacientes apresentou estresse (65,7 por cento) e não houve correlação entre estresse e número de colírios. "Tempo de tratamento", "dificuldades na vida diária" e "dificuldades em pingar o colírio" foram variáveis independentemente associadas ao estresse. Conclui-se que o estresse pode interferir negativamente no enfrentamento da doença em pacientes com GPAA.

Primary Open-Angle Glaucoma (POAG) is an important cause of blindness worldwide. This paper aimed to investigate: (a) the presence and type of stress; (b) the relationship between the number of eye-drops and stress; (c) perceptions regarding glaucoma and its treatment. In a transversal and quantitative study, we assessed 102 patients from the Ophthalmology Clinic of the HC-FMUSP by means of a thematic interview and the Lipp's Stress Symptoms Inventory (LSSI). Most of the patients were stressed (65,7 percent) and there was no correlation between stress and the number of eye-drops. "Time of treatment", "difficulties in daily life" and "difficulties to instillate the drops" were independently associated with stress. In conclusion, stress can negatively interfere in coping with POAG.

Correlation between central corneal thickness and intraocular pressure peak and fluctuation during the water drinking test in glaucoma patients

OBJECTIVE: To investigate the correlation between central corneal thickness and outflow facility assessed by intraocular pressure peak and fluctuation during the water drinking test. METHODS: Fifty-five newly diagnosed primary open-angle glaucoma patients submitted to central corneal thickness measurements and water drinking test were enrolled in this retrospective study.;. Patients were divided into three groups according to their central corneal thickness. Pearson's Correlation test was performed in the groups with lower and higher pachymetric values. RESULTS: The mean age was 65,65 ± 28,28 years; 63,63 percent were female and 52,72 percent were caucasian. The mean central corneal thickness was 544,32 ± 36,86 µm, and the mean baseline intraocular pressure was 23,36 ± 6,26 mmHg. During the water drinking test, the mean intraocular pressure peak and mean intraocular pressure fluctuation were 30,43 ± 8,13 mmHg and 31,46 ± 18,46 percent, respectively. No relevant correlation was detected between the central corneal thickness and the intraocular pressure peak (r² = 0,021) or between the central corneal thickness and the intraocular pressure fluctuation (r² = 0,011). Group 1 presented a mean central corneal thickness of 505,81 ± 13,86 µm, and Group 3 was 583,55 ± 27,87 µm (p = 0,001). The mean intraocular pressure peak was 31,05 ± 9,05 mmHg and 27,83 ± 4,92 mmHg in Group 1 and in Group 3, respectively (p = 0,193). The difference of intraocular pressure fluctuation was not statistically significant between Group 1 (mean 28,47±16,25 percent) and Group3 (mean 33,27 ± 21,27 percent) (p = 0,43). CONCLUSION: In our case series, no correlation was found between central corneal thickness and water drinkingtest results.

Patients with essential blepharospasm and glaucoma: case reports / Pacientes com glaucoma e blefaroespasmo essencial: relato de casos

Essential blepharospasm is a facial dystonia characterized by spontaneous, spasmodic and involuntary contractions of the eyelid muscles. In advanced cases, blepharospasm patients develop severe eyelid spasms that render them functionally blind, socially reclusive, and unable to work or care for themselves. Oculoplastic surgeons frequently have to deal with patients with blepharospasm. The decrease in quality of life caused by this pathology drives all the attention to the resolution of the spasms. However, other conditions may be associated with them and must be kept in mind during the ophthalmological examination. Four patients with essential blepharospasm were diagnosed as glaucomatous during their follow-up at the Oculoplastic Service. All of them showed glaucomatous optic neuropathy and corresponding visual field defect and no clinically apparent secondary cause for their glaucoma. Forced eyelid closure may lead to intraocular pressure peaks. These patients with blepharospasm present repetitive and spasmodic eyelid contractions and the intraocular pressure rise observed during eyelid squeezing could be an additional risk factor for glaucomatous damage. Our case series suggest that patients with blepharospasm should be seriously evaluated for glaucoma.

Blefaroespasmo essencial é uma distonia facial caracterizada por contrações espontâneas, espasmódicas e involuntárias dos músculos palpebrais, podendo tornar os pacientes funcionalmente cegos. Tais pacientes são geralmente referidos aos médicos oculoplásticos para avaliação e tratamento. Devido à intensidade dos espasmos e ao comprometimento da qualidade de vida, toda a atenção é dirigida à sua resolução e outras condições oculares associadas podem passar despercebidas. Neste estudo, quatro pacientes com blefaroespasmo foram diagnosticados como glaucomatosos durante o seu seguimento no Departamento de Plástica Ocular. As quatro pacientes apresentavam neuropatia óptica glaucomatosa e defeito no campo visual compatível, sem que houvesse nenhuma causa secundária para o glaucoma. O fechamento palpebral forçado causa importante aumento da pressão intra-ocular e estes pacientes com blefaroespasmo, por apresentar contrações espasmódicas e repetitivas das pálpebras, poderiam estar sob risco aumentado de desenvolver glaucoma.

Prevalence of open angle glaucoma in accompanying first degree relatives of patients with glaucoma.

OBJECTIVE: The aim of this study was to determine the prevalence of open angle glaucoma in first-degree relatives accompanying POAG patients during routine examination in a reference hospital. METHOD: First-degree relatives of primary open angle glaucoma patients who accompanied their relatives to the glaucoma service of a reference hospital were screened for glaucoma. RESULTS: One-hundred and one first-degree relatives were examined, of which 56.4% had never had their intraocular pressure measured. 10.9% had previously been diagnosed with glaucoma, and 5.9% were newly diagnosed during this study. CONCLUSIONS: The eye examination of first-degree relatives identified a significant percentage of individuals with glaucoma. Despite being first-degree relatives of glaucoma patients, 56.4% of the companions had never had their eye pressure measured, demonstrating a lack of awareness about this disease.

Avaliação da camada de fibras nervosas na retinopatia diabética tratada por panfotocoagulação com laser de argônio / Examination of the retinal nerve fiber layer in diabetic retinopathy treated by argon laser panphotocoagulation

OBJETIVO: Avaliar alterações na camada de fibras nervosas da retina na retinopatia diabética tratada por panfotocoagulação com laser de argônio. MÉTODOS: Estudo prospectivo de portadores de retinopatia diabética submetidos a panfotocoagulação retiniana. Inicialmente, foram realizados exame oftalmológico completo e tomografia de coerência óptica. Todos pacientes foram submetidos a panfotocoagulação em um dos olhos. A camada de fibras nervosas foi avaliada por meio da tomografia de coerência óptica na 1ª semana, no primeiro, terceiro e sexto meses do tratamento. RESULTADOS: A amostra foi composta por 27 pacientes (27 olhos) portadores de diabetes mellitus tipo 2. A idade variou entre 41 e 64 anos (média de 53,7 ± 6,2 anos), sendo 10 (37 por cento) pacientes do sexo masculino e 17 (63 por cento) do feminino. Quanto ao tipo de retinopatia, 22,2 por cento apresentavam RD proliferativa e 77,8 por cento, RD não proliferativa muito grave. Houve aumento significante nas medidas da espessura da camada de fibras nervosas, permanecendo nos setores temporal, 3 e 4 horas após seis meses de seguimento. Não foi observada qualquer redução na espessura em todos parâmetros analisados. CONCLUSÃO: Não foi evidenciada, a curto e médio prazo, redução na espessura da camada de fibras nervosas em portadores de retinopatia diabética tratada por panfotocoagulação que possa ser identificável por meio da tomografia de coerência óptica. Por outro lado, alguns setores mostraram aumento na espessura durante o seguimento.

PURPOSE: To evaluate the alterations in the retinal nerve fiber layer in diabetic retinopathy treated by argon laser panphotocoagulation. METHODS: Prospective study of patients with diabetic retinopathy submitted to retinal panphotocoagulation. Initially, complete ophthalmologic examination and optical coherence tomography were performed. All patients were submitted to panphotocoagulation with argon laser in one of the eyes. The retinal fiber layer was evaluated by means of optical coherence tomography in the first week, in the first, third and sixth months after treatment. RESULTS: The sample was composed of 27 patients (27 eyes) with type 2 diabetes mellitus. The age varied from 41 to 64 years (mean of 53.7 ± 6.2 years), with 10 (37 percent) males and 17 (63 percent) females. Regarding the retinopathy, 22.2 percent presented proliferative DR and 77.8 percent very severe non proliferative DR. There was a significant increase in the fiber layer thickness measurements, remaining in the temporal sectors, 3 and 4 hours, after 6 months of follow-up. Reduction of thickness was not observed in any of the analyzed parameters. CONCLUSIONS: Reduction of the fiber layer thickness, identifiable by means of optical coherence tomography, in short and average term, was not observed in patients with diabetic retinopathy treated with panphotocoagulation. On the other hand, some sectors showed thickness increase during the follow-up.