Relationship between the number of glaucoma medications, ocular surface disorder, and treatment adherence / Relação entre o número de medicamentos para glaucoma, distúrbio da superfície ocular e adesão ao tratamento

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.

Relationship between the number of glaucoma medications, ocular surface disorder, and treatment adherence.

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.

Association between Optical Coherence Tomography Measurements and Clinical Parameters in Idiopathic Intracranial Hypertension.

PURPOSE: To correlate optical coherence tomography (OCT) measurements with clinical parameters in idiopathic intracranial hypertension (IIH). METHODS: A cross-sectional study was conducted with 22 patients with IIH and 11 controls. All participants underwent comprehensive ophthalmological examination followed by spectral-domain OCT (SD-OCT) and standard automated perimetry using the 30-2 program of the Humphrey visual field analyzer. Correlations between ganglion cell complex (GCC) thickness and retinal nerve fiber layer (RNFL) thickness, as measured by SD-OCT, and clinical parameters were assessed using generalized estimating equations. RESULT: The mean age of the participants was 35.0 ± 10.83 years. The groups were similar regarding age, but were significantly different regarding sex and visual acuity (p=0.001 and p=0.038, respectively). The GCC was significantly thinner in the IIH group, with a mean of 90.535 ± 9.766 µm compared to 98.119 ± 6.988 µm for the controls (p=0.023). There was a significant association between GCC thickness and optic disc pallor (p=0.016) and between edema and visual acuity (p=0.037). No significant difference was found in RNFL thickness between patients and controls. CONCLUSION: The GCC was thinner in the patients with IIH compared to the controls, and there was an association between GCC and optic disc pallor. This might suggest a role for OCT parameters when the structural changes that occur in IIH are investigated, possibly guiding clinical decision making.

Exfoliation syndrome associated with LOXL1 gene polymorphisms in a Black patient from Latin America: a case report / Síndrome de esfoliação associada a polimorfismos do gene LOXL1 em paciente negro da América Latina: relato de caso

ABSTRACT A 89-year-old Black female with a 6-year history of advanced open-angle glaucoma was referred to the Glaucoma Service of the Ophthalmology Department - Federal University of São Paulo (UNIFESP). Best-corrected visual acuity was 20/400 in the right eye and 20/60 in the left eye. Pseudoexfoliation material was observed at the iris border, angle, and the anterior lens surface. Anterior biomicroscopy revealed exfoliation material forming an evident peripheral zone and a central disc separated by a clear intermediate zone on the anterior lens surface OU. Gonioscopy showed an open-angle Sampaolesis's line and whitish material deposits OU. Fundus examination revealed a cup-to-disc ratio of 1.0 OU with peripapillary atrophy. Genetic analysis for single nucleo­tide polymorphisms of the lysyl oxidase-like 1 gene linked to exfoliation syndrome identified two such single nucleotide polymorphisms, rs1048661 and rs216524.

RESUMO Uma mulher negra de 89 anos com um histórico de seis anos de glaucoma avançado de ângulo aberto avançado foi encaminhada ao Serviço de Glaucoma do Departamento de Oftalmologia da Universidade Federal de São Paulo (UNIFESP). A acuidade visual melhor corrigida era 20/400 no olho direito e 20/60 no olho esquerdo. Material pseudo-exfoliativo foi observado na borda iriana, ângulo e superfície anterior do cristalino. A biomicroscopia de segmento anterior demonstrou material exfoliativo formando uma zona periférica evidente e um disco central separado por uma zona intermediária livre na cápsula anterior do cristalino. A gonioscopia mostrou uma linha de Sampaolesi de ângulo aberto e depósitos esbranquiçados. O exame de fundo de olho revelou disco óptico com escavação total em ambos os olhos com atrofia peripapilar. A análise genética para polimorfismos de nucleotídeo único do gene semelhante à lysyl oxidase-like 1 ligado à síndrome de esfoliação identificou dois desses polimorfismos de nucleotídeo único, rs1048661 e rs216524.

Exfoliation syndrome associated with LOXL1 gene polymorphisms in a Black patient from Latin America: a case report.

A 89-year-old Black female with a 6-year history of advanced open-angle glaucoma was referred to the Glaucoma Service of the Ophthalmology Department - Federal University of São Paulo (UNIFESP). Best-corrected visual acuity was 20/400 in the right eye and 20/60 in the left eye. Pseudoexfoliation material was observed at the iris border, angle, and the anterior lens surface. Anterior biomicroscopy revealed exfoliation material forming an evident peripheral zone and a central disc separated by a clear intermediate zone on the anterior lens surface OU. Gonioscopy showed an open-angle Sampaolesis's line and whitish material deposits OU. Fundus examination revealed a cup-to-disc ratio of 1.0 OU with peripapillary atrophy. Genetic analysis for single nucleo-tide polymorphisms of the lysyl oxidase-like 1 gene linked to exfoliation syndrome identified two such single nucleotide polymorphisms, rs1048661 and rs216524.

Structural and functional analyses of the optic nerve and lateral geniculate nucleus in glaucoma.

PURPOSE: To analyze the correlation between structural characteristics of intraorbital optic nerve (ION) and lateral geniculate nucleus (LGN) measured by 3-Tesla magnetic resonance imaging (3T MRI), and the severity of glaucomatous damage. METHODS: In this cross-sectional study, 41 glaucoma patients and 12 age- and sex-matched controls underwent standard automated perimetry (SAP) and frequency doubling technology (FDT) as functional evaluation; optic disc stereophotograph, spectral-domain optical coherence tomography (OCT) and confocal scanning laser tomography as ocular structural evaluation; and 3T MRI. Structure-structure and structure-function correlation were performed using bootstrap resampling method for clustered data. RESULTS: The ION mean diameter and cross-sectional area were different between glaucoma and control groups at 5mm and 10mm (all, p≤0.011) from the globe, but not at 15mm (both, p≥0.067). LGN height was significantly lower in glaucoma group (p = 0.005). OCT rim area and functional parameters (SAP and FDT) correlated significantly with all ION segments, showing stronger correlations at 10 and 15 mm. ION parameters at 10 and 15 mm presented mild-to-moderate correlation with OCT peripapillary nerve fiber layer thickness, and ION at 15mm had mild association with the neuroretinal rim area on stereophotographs. Although LGN height was significantly smaller in glaucoma group (p = 0.005), LGN parameters were not associated with any ocular structural or functional parameter. CONCLUSION: Assessment of central and peripheral nervous systems using 3T MRI confirmed that glaucoma patients had smaller ION dimensions and LGN height compared to the control group. In general, ION dimensions presented mild to moderate correlations with functional and ocular structural parameters. Although ION had significant correlations at any distance from the eye, the ION distal locations correlated better with OCT results and functional parameters. However, LGN parameters were not associated with functional or ocular structural parameters.

Retinal changes in solid organ and bone marrow transplantation patients.

OBJECTIVE: To evaluate retinal changes in patients who underwent solid organ or bone marrow transplantation. METHODS: A retrospective analysis of medical records of patients evaluated from February 2009 to December 2016. All patients included underwent funduscopy. Clinical and demographic data regarding transplantation and ophthalmological changes were collected. RESULTS: A total of 126 patients were analyzed; of these, 108 underwent transplantation and 18 were in the waiting list. Transplantation modalities were heart, lung, kidney, liver, pancreas, combined pancreas and kidney and bone marrow transplantation. The main pre-transplantation comorbidities were diabetes and arterial hypertension. Of the 108 transplanted patients, 82 (76%) had retinal changes. All patients who underwent pancreas or combined pancreas and kidney transplantation had diabetic retinopathy. The main retinal changes found were diabetic retinopathy, hypertensive retinopathy, retinal vascular occlusions, chorioretinal infections and central serous chorioretinopathy. CONCLUSION: Retinal changes were either related to preexisting conditions, mainly diabetic retinopathy, or developed postoperatively as a complication of the surgical procedure, or as an infection related to the immunosuppressive status, or due to drug toxicity. These patients may present with complex ophthalmological changes and should be carefully evaluated prior to surgery and further followed by an ophthalmologist skilled in the management of diabetic retinopathy and posterior pole infections. OBJETIVO: Analisar as alterações retinianas de pacientes submetidos a transplantes de órgãos sólidos ou de medula óssea. MÉTODOS: Análise de prontuário dos pacientes avaliados no período de fevereiro de 2009 a dezembro de 2016. Todos os pacientes incluídos foram submetidos à avaliação fundoscópica. Foram coletados dados demográficos e clínicos, referentes ao transplante e às alterações oftalmológicas encontradas. RESULTADOS: Foram avaliados 126 pacientes, sendo 108 submetidos a transplantes e 18 que aguardavam o procedimento. Foram avaliados pacientes submetidos a transplantes de coração, pulmão, rim, fígado, pâncreas, pâncreas-rim e medula óssea. As principais comorbidades pré-transplante foram diabetes e hipertensão arterial. Dos 108 pacientes transplantados, 82 (76%) apresentaram alterações retinianas. Todos os pacientes submetidos ao transplante de pâncreas ou pâncreas-rim apresentaram alterações retinianas relacionadas ao diabetes. As principais alterações retinianas detectadas foram retinopatia diabética, retinopatia hipertensiva, oclusões vasculares retinianas, infecções coriorretinianas e coriorretinopatia serosa central. CONCLUSÃO: As alterações retinianas estavam relacionadas a doenças preexistentes, principalmente à retinopatia diabética, ou surgiram após o transplante, como complicação do procedimento cirúrgico, ou como complicação infecciosa associada à imunossupressão, ou ainda por toxicidade medicamentosa. Tais pacientes podem apresentar alterações oculares complexas, devendo ser submetidos à avaliação retiniana pré-operatória cuidadosa e ao acompanhamento pós-operatório por oftalmologista especializado no manejo da retinopatia diabética e de doenças infecciosas do segmento posterior ocular.

Retinal changes in solid organ and bone marrow transplantation patients / Alterações retinianas em pacientes de um programa de transplante de órgãos sólidos e de medula óssea

ABSTRACT Objective To evaluate retinal changes in patients who underwent solid organ or bone marrow transplantation. Methods A retrospective analysis of medical records of patients evaluated from February 2009 to December 2016. All patients included underwent funduscopy. Clinical and demographic data regarding transplantation and ophthalmological changes were collected. Results A total of 126 patients were analyzed; of these, 108 underwent transplantation and 18 were in the waiting list. Transplantation modalities were heart, lung, kidney, liver, pancreas, combined pancreas and kidney and bone marrow transplantation. The main pre-transplantation comorbidities were diabetes and arterial hypertension. Of the 108 transplanted patients, 82 (76%) had retinal changes. All patients who underwent pancreas or combined pancreas and kidney transplantation had diabetic retinopathy. The main retinal changes found were diabetic retinopathy, hypertensive retinopathy, retinal vascular occlusions, chorioretinal infections and central serous chorioretinopathy. Conclusion Retinal changes were either related to preexisting conditions, mainly diabetic retinopathy, or developed postoperatively as a complication of the surgical procedure, or as an infection related to the immunosuppressive status, or due to drug toxicity. These patients may present with complex ophthalmological changes and should be carefully evaluated prior to surgery and further followed by an ophthalmologist skilled in the management of diabetic retinopathy and posterior pole infections.

RESUMO Objetivo Analisar as alterações retinianas de pacientes submetidos a transplantes de órgãos sólidos ou de medula óssea. Métodos Análise de prontuário dos pacientes avaliados no período de fevereiro de 2009 a dezembro de 2016. Todos os pacientes incluídos foram submetidos à avaliação fundoscópica. Foram coletados dados demográficos e clínicos, referentes ao transplante e às alterações oftalmológicas encontradas. Resultados Foram avaliados 126 pacientes, sendo 108 submetidos a transplantes e 18 que aguardavam o procedimento. Foram avaliados pacientes submetidos a transplantes de coração, pulmão, rim, fígado, pâncreas, pâncreas-rim e medula óssea. As principais comorbidades pré-transplante foram diabetes e hipertensão arterial. Dos 108 pacientes transplantados, 82 (76%) apresentaram alterações retinianas. Todos os pacientes submetidos ao transplante de pâncreas ou pâncreas-rim apresentaram alterações retinianas relacionadas ao diabetes. As principais alterações retinianas detectadas foram retinopatia diabética, retinopatia hipertensiva, oclusões vasculares retinianas, infecções coriorretinianas e coriorretinopatia serosa central. Conclusão As alterações retinianas estavam relacionadas a doenças preexistentes, principalmente à retinopatia diabética, ou surgiram após o transplante, como complicação do procedimento cirúrgico, ou como complicação infecciosa associada à imunossupressão, ou ainda por toxicidade medicamentosa. Tais pacientes podem apresentar alterações oculares complexas, devendo ser submetidos à avaliação retiniana pré-operatória cuidadosa e ao acompanhamento pós-operatório por oftalmologista especializado no manejo da retinopatia diabética e de doenças infecciosas do segmento posterior ocular

New adjustable suture technique for trabeculectomy.

PURPOSE: To describe an adjustable suture (AS) experimental model that allows for tightening, loosening and retightening of the suture tension in trabeculectomy. METHODS: Standard trabeculectomy was performed in fifteen pig eyeballs. All pig eyes were tested twice: one test with conventional suture in both flap's corners (conventional suture group) and another test with a conventional suture at one corner and an adjustable suture in the other corner (AS group). The order in which each test was performed was defined by randomization. Intraocular pressure was measured at three time points: T1) when the knots were tightened; T2) when the AS was loosened or the conventional knot was removed; and T3) when the AS was retightened in the AS group or five minutes after the knot removal in the conventional suture group. RESULTS: The mean Intraocular pressure was similar between the two groups at time point 1 (p=0.97). However, significant Intraocular pressure differences were found between eyes in the conventional and adjustable suture groups at time points 2 (12.6 ± 4.2 vs 16.3 ± 2.3 cmH2O, respectively, p=0.006) and 3 (12.2 ± 4.0 vs 26.4 ± 1.7 cmH2O, respectively; p=0.001). While the conventional technique allowed only Intraocular pressure reduction (following the knot removal; T2 and T3), the AS technique allowed both Intraocular pressure reduction (T2) and elevation (T3) through the management (loosening and retightening) of the suture. CONCLUSION: This experimental model provides an effective noninvasive postoperative mechanism of suture tension adjustment.

New adjustable suture technique for trabeculectomy / Nova técnica de sutura ajustável para trabeculectomia

PURPOSE: To describe an adjustable suture (AS) experimental model that allows for tightening, loosening and retightening of the suture tension in trabeculectomy. METHODS: Standard trabeculectomy was performed in fifteen pig eyeballs. All pig eyes were tested twice: one test with conventional suture in both flap's corners (conventional suture group) and another test with a conventional suture at one corner and an adjustable suture in the other corner (AS group). The order in which each test was performed was defined by randomization. Intraocular pressure was measured at three time points: T1) when the knots were tightened; T2) when the AS was loosened or the conventional knot was removed; and T3) when the AS was retightened in the AS group or five minutes after the knot removal in the conventional suture group. RESULTS: The mean Intraocular pressure was similar between the two groups at time point 1 (p=0.97). However, significant Intraocular pressure differences were found between eyes in the conventional and adjustable suture groups at time points 2 (12.6 ± 4.2 vs 16.3 ± 2.3 cmH2O, respectively, p=0.006) and 3 (12.2 ± 4.0 vs 26.4 ± 1.7cmH2O, respectively; p=0.001). While the conventional technique allowed only Intraocular pressure reduction (following the knot removal; T2 and T3), the AS technique allowed both Intraocular pressure reduction (T2) and elevation (T3) through the management (loosening and retightening) of the suture. CONCLUSION: This experimental model provides an effective noninvasive postoperative mechanism of suture tension adjustment.

OBJETIVO: Descrever uma nova técnica de sutura ajustável para o "flap" da trabeculectomia (TREC), que permite apertar e folgar a sutura no pós-operatório. MÉTODOS: Foram realizadas trabeculectoomia em 15 olhos de porco. Todos os olhos de porco foram testados duas vezes; um teste com sutura convencional nas duas extremidades do "flap"(grupo sutura convencional), outro teste com sutura convencional em uma das extremidades e na outra extremidade a sutura ajustável proposta por esse trabalho (grupo sutura ajustável). A ordem de qual teste seria realizado primeiro em cada olho foi definida por sorteio. A pressão intraocular foi medida de forma direta em três momentos: T1) Todas as suturas apertadas; T2) Após lise de uma sutura convencional ou de afrouxar a sutura ajustável; T3) Após apertar novamente a sutura ajustável ou no caso do teste com as duas suturas convencionais após 5 minutos da lise de uma das suturas. RESULTADOS: No primeiro momento de medida da pressão intraocular (T1) as pressões médias foram similares entre os dois grupos (p=0.97). No entanto, diferenças significativas em relação a pressão intraocular foram encontradas entre os grupos de sutura convencional e ajustável nos tempos 2 (12,6 ± 4,2 vs 16,3 ± 2,3 cmH2O, respectivamente; p=0,006) e 3 (12,2 ± 4,0 vs 26,4 ± 1.7cmH2O, respectivamente; p=0,001). Enquanto a técnica convencional permitiu somente a redução da pressão intraocular após a remoção da sutura (T2 e T3), a técnica de sutura ajustável permitiu tanto a redução (T2) quanto a elevação da pressão intraocular (T3) através do manejo da sutura. CONCLUSÃO: Esse modelo experimental demonstrou a eficácia de uma possível técnica não-invasiva para ajuste da tensão da sutura do "flap"no pós-operatório da trabeculectomia.

Silicone Ahmed glaucoma valve with and without intravitreal triamcinolone acetonide for neovascular glaucoma: randomized clinical trial.

PURPOSE: To compare the effect on intraocular pressure (IOP) of the silicone Ahmed glaucoma valve with and without an intravitreal injection of triamcinolone acetonide. PATIENTS AND METHODS: Forty-nine patients with clinically uncontrolled neovascular glaucoma were included in the study; 22 were randomly assigned to the study group (silicone Ahmed glaucoma valve implant with intravitreal triamcinolone acetonide) and 27 to the control group (silicone Ahmed glaucoma valve). IOP was the primary outcome measure in this study. The secondary outcome measure was success, defined by IOP lower than 22 mm Hg and higher than 5 mm Hg, and no serious complications. Success rates in both the groups were compared using Kaplan-Meier survival curves and the log-rank test. IOP levels were compared using mixed linear model analysis to correct for repeated measures correlation. RESULTS: Forty-three patients, 18 in the study group and 25 in the control group, completed the study (follow-up of 12 mo). The mean IOP was significantly lower after 1 year in both the groups (P<0.001). The mean IOP in the first month of follow-up was lower in the study group (control; 20.4±9.7, study; 13.6±6.5, P<0.01). The success rate at 1 year was 78% for the study group and 76% for the control group (P=0.82). Complication rates were not different between the groups. CONCLUSIONS: Intravitreal injection of triamcinolone acetonide in neovascular glaucoma did not affect the intermediate-term success of the silicone Ahmed valve nor reduce the incidence of complications. The mean IOP spike in the first month was lower in the triamcinolone group.

The potential neuroprotective effects of weekly treatment with glatiramer acetate in diabetic patients after panretinal photocoagulation.

PURPOSE: Evaluation of the neuroprotective effect of weekly glatiramer acetate (GA) on retinal structure and function in diabetic patients who underwent panretinal photocoagulation (PRP). PATIENTS AND METHODS: patients with severe nonproliferative or early diabetic proliferative retinopathy and no previous laser treatment were randomly divided into two groups: (1) those who received four GA treatments and (2) those who received placebo treatment. The subcutaneous injections were administered 1 week prior to laser and weekly in the subsequent three sessions of PRP in both groups. All patients underwent a full ophthalmic examination (best-corrected logMAR visual acuity, slit lamp examination, applanation tonometry, fundus biomicroscopy and indirect fundus examination); functional examination (standard automated perimetry, electroretinography and frequency-doubling technology C-20 visual field) and anatomic examination (color photography, optical coherence tomography (OCT) and Heidelberg retinal tomography). The examinations were performed before the photocoagulation and repeated 1,3,6, and 12 months after treatment (in a double-masked manner). To compare the two groups, generalized estimating equation models were performed to account for the dependence between eyes of the same patient. RESULTS: Thirteen patients (23 eyes) were included in the study group and 13 patients (24 eyes) were included in the control group. OCT showed a statistically significant difference in retinal nerve fiber layer (RNFL) thickness in the inferior peripapillary region and average thickness with thinner measurements in the control group at 1-year post-PRP. Functional analysis demonstrated a difference between groups, but it did not reach statistical significance. CONCLUSION: The results of this study suggest that weekly GA treatment has a potential neuro-protective effect on the RNFL following photocoagulation for diabetic retinopathy.

[Association between optic disc hemorrhages and the position of central retinal vessels]. / Hemorragia peripapilar em pacientes com glaucoma e sua relação com o tronco vascular retiniano.

PURPOSE: To investigate the correlation between optic disc hemorrhages (ODHs) and the position of the central retinal vessel trunk (RVT) in patients with glaucoma. METHODS: Fundus photographs of 1,830 participants were reviewed. The exit position of the central retinal vessel trunk was classified as being in the superior or inferior hemisphere of the optic disc and the relative vertical position was expressed as a fraction of the disc diameter (ratio between the position of the trunk and the diameter of the disk). A group of patients from the same population, but without ODHs, was randomly selected and compared with the patients with ODHs. RESULTS: Among the 1,830 patients, 53 hemorrhages were detected in 41 patients with glaucoma or suspected glaucoma. We found an inverse relationship between the inferior/superior position of the central RVT and the inferior/superior position of the hemorrhages (Kappa=-0.34). Using the trunk/disc ratio, we found that superior ODHs correlated with inferior RVTs (trunk/disc ratio, 0.450; SD=0.070) and inferior ODHs correlated with superior RVTs (trunk/disc ratio, 0.510; SD=0.054) (p=0.027). The number of patients with normal tension glaucoma was significantly higher among patients with ODHs than among those without ODHs (p=0.009). CONCLUSION: Our patients had a negative correlation between the position of central RVT and the location of the ODHs. Normal tension glaucoma was more prevalent among patients with ODHs than among those without it.

Hemorragia peripapilar em pacientes com glaucoma e sua relação com o tronco vascular retiniano / Association between optic disc hemorrhages and the position of central retinal vessels

OBJETIVOS: Avaliar a correlação entre as hemorragias peripapilares (HPPs) e a posição do tronco vascular na cabeça do nervo óptico. MÉTODOS: Retinografias de 1.830 pacientes foram revisadas. A posição do tronco vascular retiniano (TVR) foi classificada de acordo com sua localização no hemisfério superior ou inferior e sua posição relativa através da razão entre a distância entre o TVR e o ponto mais inferior do disco óptico e o diâmetro vertical do disco óptico (razão tronco/disco). Pacientes da mesma população, com glaucoma e sem HPPs foram aleatoriamente selecionados para comparação. RESULTADOS: Dos 1.830 pacientes, 46 apresentaram HPPs. Foram detectadas 53 hemorragias em 41 pacientes com glaucoma ou suspeitos de glaucoma, principalmente na região temporal inferior (47,2 por cento). Observou-se concordância negativa entre a localização superior ou inferior do TVR e das HPPs (Kappa= -0,34). Considerando a posição relativa do TVR em relação ao diâmetro vertical do disco óptico (razão tronco/disco), encontramos melhor correlação (valores médios da razão tronco/disco: 0,450-hemorragias superiores e 0,510-hemorragias inferiores; p=0,027). No grupo com HPPs, observamos porcentagem significativamente maior de pacientes com glaucoma de pressão normal (GPN) se comparado ao grupo sem hemorragia (p=0,009). CONCLUSÃO: HPPs foram mais comuns no hemisfério oposto ao da emergência do TVR. Observamos maior prevalência de GPN nos pacientes com hemorragias que nos sem hemorragia.

PURPOSE: To investigate the correlation between optic disc hemorrhages (ODHs) and the position of the central retinal vessel trunk (RVT) in patients with glaucoma. METHODS: Fundus photographs of 1,830 participants were reviewed. The exit position of the central retinal vessel trunk was classified as being in the superior or inferior hemisphere of the optic disc and the relative vertical position was expressed as a fraction of the disc diameter (ratio between the position of the trunk and the diameter of the disk). A group of patients from the same population, but without ODHs, was randomly selected and compared with the patients with ODHs. RESULTS: Among the 1,830 patients, 53 hemorrhages were detected in 41 patients with glaucoma or suspected glaucoma. We found an inverse relationship between the inferior/superior position of the central RVT and the inferior/superior position of the hemorrhages (Kappa= -0.34). Using the trunk/disc ratio, we found that superior ODHs correlated with inferior RVTs (trunk/disc ratio, 0.450; SD=0.070) and inferior ODHs correlated with superior RVTs (trunk/disc ratio, 0.510; SD=0.054) (p=0.027). The number of patients with normal tension glaucoma was significantly higher among patients with ODHs than among those without ODHs (p=0.009). CONCLUSION: Our patients had a negative correlation between the position of central RVT and the location of the ODHs. Normal tension glaucoma was more prevalent among patients with ODHs than among those without it.

Vitamin D receptor gene polymorphism and bone mineral density in hypercalciuric calcium-stone-forming patients.

Reduced bone mineral density (BMD) and an increased risk of vertebral fracture have been reported in calcium-stone-forming (CSF) patients presenting with idiopathic hypercalciuria. We investigated the association between BsmI vitamin D receptor (VDR) polymorphism and BMD in 68 hypercalciuric CSF patients (35 males and 33 premenopausal females, mean age +/- SD = 39 +/- 10 years). BMD was measured at lumbar spine (L2-L4) and femur neck sites using dual energy X-ray absorptiometry. A 72-hour dietary record and a 24-hour urine sample were obtained from each patient to determine calcium intake and excretion. The allelic frequency found for the sample as a whole was 16% BB, 44% Bb and 40% bb. Mean BMD values did not significantly differ among BB, Bb and bb patients at L2-L4 (1.162 +/- 0.10, 1.133 +/- 0.11 and 1.194 +/- 0.19 g/cm2, mean +/- SD, respectively) or at neck sites (0.920 +/- 0.11, 0.931 +/- 0.15 and 0.982 +/- 0.15 g/cm2, respectively). Calcium intake and excretion were also not significantly different among the three genotypes. Patients were then divided into two groups, normal BMD, T-score > or =-1 (n = 34) and low BMD, T-score <-1 (n = 34), to further evaluate the allele influence on previous bone loss. Despite a trend for a higher mean BMD at spine or neck sites for patients with one or two b alleles when compared to BB patients, the difference did not reach statistical significance. The distribution of BB, Bb and bb genotypes in the low-bone-mass group (15, 47 and 38%, respectively) was similar to that in the normal-bone-mass group (18, 41 and 14%, respectively). These data suggest that BsmI VDR polymorphism does not play an important role in the bone loss seen in hypercalciuric CSF patients.