Primary open-angle glaucoma in patients with obstructive sleep apnoea in a Colombian population: a cross-sectional study.

OBJECTIVE: Determine the prevalence, functional and structural alterations of primary open-angle glaucoma (POAG) in patients with obstructive sleep apnoea (OSA). DESIGN: Cross-sectional. SETTING: Tertiary hospital associated with specialised center in ophthalmologic images in Bogota, Colombia. PARTICIPANTS: 150 patients, for a sample of 300 eyes, 64 women (42.7%) and 84 men (57.3%) between 40 and 91 years old with a mean age of 66.8 (±12.1) years. INTERVENTIONS: Visual acuity, biomicroscopy, intraocular pressure, indirect gonioscopy and direct ophthalmoscopy. Patients classified as glaucoma suspects underwent automated perimetry (AP) and optical coherence tomography of the optic nerve OUTCOME MEASURE: The primary outcomes are the determination of prevalence of glaucoma suspects and POAG in patients with OSA. Secondary outcomes are the description of functional and structural alterations in computerised exams of patients with OSA. RESULTS: The prevalence of glaucoma suspect was 12.6%, and for POAG was 17.3%. No alterations in the appearance of the optic nerve was seen in 74.6%, focal or diffuse thinning of the neuroretinal rim (16.6%) was the most frequently finding, followed by asymmetry of the disc>0.2 mm (8.6%) (p=0.005). In the AP, 41% showed arcuate, nasal step and paracentral focal defects. The mean retinal nerve fiber layer (RNFL) was normal (>80 µM) in 74% of the mild OSA group, 93.8% of the moderate group and 17.1% of the severe group. Similarly, normal (P5-90) ganglion cell complex (GCC) in 60%, 68% and 75%, respectively. Abnormal results in the mean RNFL was seen in 25.9%, 6.3% and 23.4% of the mild, moderate and severe groups, respectively. In the GCC, 39.7%, 33.3% and 25% of the patients in the aforementioned groups. CONCLUSION: It was possible to determine the relationship between structural changes in the optic nerve and the severity of OSA. No relationship with any of the other studied variables was identified.

Efecto Hipotensor de la Trabeculoplastia Láser / Hypotensive Eff ect of Laser Trabeculoplasty

Objetivo: Reportar el desenlace luego de 12 meses de seguimiento, en pacientes en los que se realizó una queratoplastia lamelar anterior profunda (DALK) asistida con láser de femtosegundo. Metodología: Se realizó un estudio descriptivo, retrospectivo, mediante revisión de historias clínicas de pacientes sometidos a DALK asistida con láser de femtosegundo (Wavelight FS-200 ® Alcon. Forth Worth, Texas), utilizando la configuración de zig-zag. Las indicaciones de DALK incluyeron queratocono, ectasia post LASIK y leucoma como secuela de queratitis infecciosa. Las variables estudiadas fueron agudeza visual mejor corregida, cilindro queratométrico, refracción final y complicaciones intra y post operatoria. Resultados: En total se incluyeron 10 ojos de 10 pacientes, en todos los ojos se llevó a cabo con éxito femto-DALK y no hubo ninguna complicación intra operatoria. En el postoperatorio se presentó un caso de rechazo estromal, un caso de hipertensión ocular secundario a esteroides y un caso de retraso en la cicatrización. El seguimiento promedio fue de 13, 1 meses (R= 12 ­ 15 meses). La Agudeza Visual Mejor Corregida (AVMC) preoperatoria promedio fue LogMAR 0,96 (R= 0,54 ­ 1,60). La AVMC postoperatoria promedio a los 12 meses fue 0,10 (R= 0,00 ­ 0,17). El equivalente esférico preoperatorio medio fue -12,6 Dioptrias (D) (R= -5,0 a -15,0D) y el postoperatorio fue -2,57 D (R= -0,50 a -6,25 D). El astigmatismo queratométrico preoperatorio medio de -11.5D (R= -7.0 a -23D) y el postoperatorio -2,4 D (R= -0,75 a -3,75 D). Conclusión: La femto-DALK en configuración Zig-Zag es un procedimiento confiable, con baja tasa de complicaciones intra y postoperatorias. El resultado refractivo es comparable con la queratoplastia penetrante, y ofrece beneficios sobre factores de estabilidad biomecánica y recuperación del paciente en el primer año postoperatorio.

Objective: The aim was to report the surgical outcomes of twelve months follow-up after femtosecond laser assisted Zig-zag confi guration combined with Deep Anterior Lamellar Keratoplasty (Femto-DALK). Methods: A descriptive, retrospective study, which evaluated and assisted medical records of patients who had undergone deep anterior lamellar keratoplasty (DALK) femtosecond laser assisted. Ten eyes of ten consecutive patients underwent femtosecond (Wavelight FS-200 ® Alcon. Forth Worth, Texas) laser-assisted zig-zag configuration combined with Anwar´s big-bubble technique DALK, from April 2012 to December 2013. The diagnosis of the patients were keratoconus, corneal ectasia and scarring following infectious keratitis. Variables measured were: Best corrected visual acuity, keratometric corneal cylinder, final refraction and intraand postoperative complications were analyzed. Results: The procedure was performed without any complications in all patients. There was only a single case of stromal graft rejection, a case of corticosteroid induced ocular hypertension and a case of delayed corneal epithelial healing. Mean follow-up period was 13.1 months (R= 12­15 months). The mean preoperative BCVA was LogMAR 0,96 (R= 0,54 ­ 1,60). The mean postoperative BCVA at 12th month was 0,054 (R= 0,00 ­0,09). The mean preoperative spherical equivalent (SE) was -12,6 Diopter (D) (R= -5,0 to -24,0D) and postoperative SE was -2,50 D (R=-0,50 to -6,25 D). The measurements of keratometric corneal cylinder preoperative was -11.5D (R= -7.0 a -23D) and postoperative refractive cylinder was -2,4 D (R=-0,75 to -4,00 D). Conclusion: Laser-assisted zig-zag configuration combined with Anwar´s big-bubble technique DALK is a safe procedure. The rate of intra and postoperative complications is low. The refractive outcomes are comparable to penetrating keratoplasty, but better biomechanical stability of the cornea and a faster visual recovery with femtoDALK procedure.