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2.
J Glaucoma ; 31(5): 346-350, 2022 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-34999664

RESUMO

PRCIS: Trabeculotomy (T) alone is as safe and effective as combined trabeculotomy-trabeculectomy (TT) in patients with primary congenital glaucoma (PCG) and requires significantly fewer examinations under anesthesia in the postoperative period. PURPOSE: The purpose of this study was to compare the outcomes of T and combined TT as the initial surgical procedure for patients with PCG. METHODS: In this retrospective study, medical records of patients who had undergone T or TT as the initial procedure for PCG were reviewed. The primary outcome measure was a surgical success, defined as 5≤ intraocular pressure (IOP) ≤21 mm Hg, IOP reduction of at least 20% with no need for further glaucoma surgery. Secondary outcome measures were the number of glaucoma medications and complications. RESULTS: A total of 134 eyes from 134 patients with a mean follow-up of 8±6.6 years were included consisting of 106 and 28 eyes, which had undergone T and TT, respectively. Success rates were comparable with both surgical procedures at 1, 2, 3, 4, and 5 years with no statistically significant difference. IOP was significantly decreased from 27.5±4.2 mm Hg preoperatively to 15.62±3.4 mm Hg at the 5-year follow-up visit in the T group and from 25.3±6.5 to 17.1±3.2 mm Hg in the TT group (P=0.1) there was no significant difference between the 2 groups in the number of glaucoma medications (P=0.2). Patients in the T group required significantly fewer examinations under anesthesia than the TT group (7.3±4.4 vs. 10.1±3.9, P=0.04). CONCLUSION: Trabeculotomy alone seems as effective as combined trabeculotomy-trabeculectomy and may significantly reduce exposure to anesthesia in primary congenital glaucoma patients.


Assuntos
Glaucoma , Trabeculectomia , Glaucoma/etiologia , Humanos , Pressão Intraocular , Estudos Retrospectivos , Trabeculectomia/métodos , Resultado do Tratamento
4.
Eur J Ophthalmol ; : 11206721211051235, 2021 Nov 03.
Artigo em Inglês | MEDLINE | ID: mdl-34730456

RESUMO

BACKGROUND/OBJECTIVES: This study aims to report the developmental and histopathological features of ocular tissues from an electively aborted human fetus with mutations in cytochrome p4501B1, and thus predisposed to primary congenital glaucoma in comparison to an age-matched healthy fetal globe. SUBJECTS/METHODS: Both eyes of two 17-week gestational aged fetuses, the first with CYP1B1 mutations and the second as healthy control fetus, were studied. Hematoxylin and eosin, Periodic acid-Schiff, Gomori's trichrome, and Verhoeff-Van Gieson staining protocols in addition to immunohistochemistry staining using anti-cytochrome p4501B1, anti-fibrillin-1, and anti-4-hydroxy-2-nonenal antibodies, as primary antibodies, were performed to assess the effect of the mutations on tissue development, cytochrome p4501B1 protein expression, extracellular matrix structure, and oxidative stress in the developing fetus eye. Quantitative analyses were performed using ImageJ software. Student's t-test was used for statistical analysis and P-values <0.05 were considered as significant. RESULTS: Delayed development in ocular tissues, decreased expression of cytochrome p4501B1 protein, irregular extracellular matrix structure, and increased oxidative stress biomarker were evident in the ocular tissues of the fetus with cytochrome p4501B1 mutations as compared to a normal globe from an age-matched fetus. CONCLUSION: To the best of our knowledge, this is the first report of prenatal diagnosis of primary congenital glaucoma. We also describe histopathological changes in the primary congenital glaucoma-affected globes revealing the effect of cytochrome p4501B1 deficiency on ocular tissues during early fetal development contributing to the glaucoma phenotype.

5.
J Glaucoma ; 30(12): 1074-1081, 2021 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-34628431

RESUMO

PRCIS: Glaucoma surgery in 1 eye can result in significant intraocular pressure (IOP) elevation in the fellow eye in a significant percentage of subjects. This effect is more pronounced following glaucoma drainage device implantation and in subjects developing postoperative hypotony in the first eye. PURPOSE: The aim was to investigate the course and magnitude of IOP changes in contralateral eyes following glaucoma surgery. PATIENTS AND METHODS: We studied 131 glaucoma patients undergoing surgery. IOP changes in fellow eyes and the number of glaucoma medications were recorded for 6 months. Both normal and glaucomatous fellow eyes were included. Patients on preoperative acetazolamide were analyzed separately. IOP change ≥4 mm Hg or 20% increase from baseline values was considered significant. RESULTS: Baseline IOP in fellow eyes was 13.1±3.3 mm Hg which increased significantly at all-time points with a peak at 1 week (mean increase: 3.1±3.2 mm Hg) gradually decreasing up to 6 months (mean increase 0.9±2.1 mm Hg). The number of fellow eyes with clinically significant IOP elevation at 1 day, 1 week, and 1, 3. and 6 months was 47, 76, 47, 31, and 37 showing mean IOP rise of 4.5±2.3 (38.5%), 5.4±1.8 (48.5%), 4.8±1.6 (44.2%), 3.7±1.3 (36.5%), and 3.2±1.3 (32.6%) mm Hg, respectively. Medications were added to 18 fellow eyes (including 10 initially "normal" eyes) while 7 other fellow eyes required surgery.Significant IOP elevation in fellow eyes was associated with tube shunt surgery (P<0.008 at all-time points), a diagnosis of glaucoma following cataract surgery, IOP ≤5 mm Hg on the first postoperative day (P=0.002) and use of preoperative acetazolamide. CONCLUSION: Glaucoma surgery was associated with IOP elevation in fellow eyes in a significant number of subjects and suggests that IOP in the unoperated eye should also be checked at postoperative visits.


Assuntos
Extração de Catarata , Implantes para Drenagem de Glaucoma , Glaucoma , Glaucoma/cirurgia , Humanos , Pressão Intraocular , Estudos Retrospectivos , Tonometria Ocular
6.
J Drug Assess ; 10(1): 91-96, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34447609

RESUMO

OBJECTIVE: This study aimed to compare the therapeutic efficacy and safety of dorzolamide/timolol fixed-combination(Cosopt) in newly diagnosed primary open-angle glaucoma (POAG) patients. METHODS: In this prospective, interventional case series, newly POAG patients were included. Patients were started on Cosopt twice a day (BID) for one month and then switched to three times a day (TDS) for an additional month. Patients underwent comprehensive ophthalmic examination, diurnal intraocular pressure (IOP), blood pressure (BP), and 24-h heart rate (HR) measurements at baseline, month 1(BID), and month 2(TDS). Throughout the study, all adverse events were monitored by the investigators. RESULTS: In 31 POAG patients that completed the study, the mean baseline IOP was 23.1 ± 3.15 mmHg. IOP was decreased significantly 16.5 ± 2.21 at one month (p < .0001) and 13.9 ± 2.23 mmHg at 1 and 2 months follow up (p < .0001). IOP was significantly lower in month 2 compared to month 1 (p = .0004). While Cosopt BID significantly reduced the mean 24-h systolic BP and mean 24-h HR from baseline (p < .0001), the mean 24-h systolic BP and HR remained unchanged with Cosopt TDS compared to BID (p = .62). CONCLUSIONS: Cosopt TDS has a superior IOP-lowering effect than Cosopt BID in POAG patients with comparable safety profiles.

7.
J Ophthalmic Vis Res ; 16(2): 148-150, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34055250
8.
Ophthalmol Glaucoma ; 4(1): 95-101, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-32827800

RESUMO

PURPOSE: To investigate characteristics of the lamina cribrosa (LC) and prelaminar tissue (PLT) in eyes of patients with primary open-angle glaucoma (POAG), primary angle-closure glaucoma (PACG), and pseudoexfoliation glaucoma (PXG) using enhanced depth imaging (EDI) OCT. DESIGN: Observational case-control study. PARTICIPANTS: A total of 116 eyes from 116 participants with POAG (n = 30 eyes), PACG (n = 29 eyes), or PXG (n = 29 eyes) and 28 healthy eyes. METHODS: Participants underwent a complete ophthalmologic examination in addition to corneal pachymetry, standard achromatic perimetry, peripapillary retinal nerve fiber layer (RNFL) OCT, and EDI OCT, as well as measurement of LC, PLT thickness, and LC depth. MAIN OUTCOME MEASURES: Lamina cribrosa measurement, PLT thickness, and LC thickness. RESULTS: Average LC thickness was significantly different among the 4 groups with the thinnest values in the PXG group. Prelaminar tissue also was significantly thinner in PXG eyes. The POAG eyes demonstrated the largest LC depths (P < 0.05), whereas PACG and healthy eyes demonstrated the smallest LC depths (P < 0.05). Mean deviation on standard achromatic perimetry and average thickness on peripapillary RNFL OCT were associated significantly with LC and PLT thickness. CONCLUSIONS: Pseudoexfoliation glaucoma eyes demonstrate reduced LC and PLT thickness compared with POAG, PACG, and healthy eyes. Lamina cribrosa depth was larger in POAG eyes as compared with PXG, PACG, and healthy eyes. These findings may account for the peculiar appearance of the optic nerve head in PXG eyes.


Assuntos
Glaucoma de Ângulo Aberto , Glaucoma , Estudos de Casos e Controles , Glaucoma de Ângulo Aberto/diagnóstico , Humanos , Pressão Intraocular , Tomografia de Coerência Óptica , Campos Visuais
9.
J Cataract Refract Surg ; 47(6): 773-779, 2021 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-33252568

RESUMO

PURPOSE: To investigate the potential additive effect of systemic supplemental oxygen administered during accelerated corneal crosslinking (CXL) for progressive keratoconus (KC). SETTING: Academic center. DESIGN: Randomized clinical trial. METHODS: Eyes with progressive KC randomized to 3 different CXL protocols were included. The first group (OA-CXL) included 19 eyes that underwent an accelerated CXL protocol (9 mW/cm2 for 10 minutes) while receiving systemic oxygen at a rate of 5 L/min for 10 minutes. The second group consisted of 14 eyes undergoing the same accelerated CXL protocol without supplemental oxygen therapy (A-CXL). The third group (C-CXL) comprised 14 eyes undergoing conventional CXL according to the Dresden protocol. All subjects were followed up for at least 6 months. Visual acuity, keratometry and corneal biomechanical parameters including corneal hysteresis and corneal resistance factor (CRF) were measured preoperatively and 6 months postoperatively. RESULTS: Reduction in maximum keratometry (Kmax) was significantly greater in the OA-CXL group (P = .01). At baseline, the mean Kmax was 54.31 ± 3.64 diopters (D) in the OA-CXL group, 54.66 ± 4.99 D in the A-CXL group, and 56.03 ± 5.28 D in the C-CXL group (P = .58), which reached 53.58 ± 3.24 D, 54.59 ± 4.65 D, and 55.87 ± 4.73 D at 6 months in the 3 study groups, respectively (P = .115). The mean CRF increased significantly only in the OA-CXL group from a baseline value of 6.32 ± 2.12 mm Hg to 7.38 ± 1.88 mm Hg at 6 months (P = .009). CONCLUSIONS: This study suggests superior efficacy of an accelerated CXL protocol coupled with systemic oxygen supplementation when compared with the accelerated CXL protocol and the conventional protocol in eyes with progressive KC. In addition to greater reduction in Kmax as the primary outcome, improvement in corneal biomechanics was also observed at 6 months.


Assuntos
Ceratocone , Fotoquimioterapia , Colágeno/uso terapêutico , Córnea , Topografia da Córnea , Reagentes de Ligações Cruzadas/uso terapêutico , Humanos , Ceratocone/tratamento farmacológico , Oxigênio/uso terapêutico , Oxigenoterapia , Fármacos Fotossensibilizantes/uso terapêutico , Riboflavina/uso terapêutico , Raios Ultravioleta
10.
Brain Behav ; 10(10): e01799, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32803874

RESUMO

AIMS: We developed a glaucoma-on-a-chip model to evaluate the viability of retinal ganglion cells (RGCs) against high pressure and the potential effect of neuroprotection. METHODS: A three-layered chip consisting of interconnecting microchannels and culture wells was designed and fabricated from poly-methyl methacrylate sheets. The bottom surface of the wells was modified by air plasma and coated with different membranes to provide a suitable extracellular microenvironment. RGCs were purified from postnatal Wistar rats by magnetic assisted cell sorting up to 70% and characterized by flow cytometry and immunocytochemistry. The cultured RGCs were exposed to normal (15 mmHg) or elevated pressure (33 mmHg) for 6, 12, 24, 36, and 48 hr, with and without adding brain-derived neurotrophic factor (BDNF) or a novel BDNF mimetic (RNYK). RESULTS: Multiple inlet ports allow culture media and gas into the wells under elevated hydrostatic pressure. PDL/laminin formed the best supporting membrane. RGC survival rates were 85%, 78%, 70%, 67%, and 61% under normal pressure versus 40%, 22%, 18%, 12%, and 10% under high pressure at 6, 12, 24, 36, and 48 hr, respectively. BDNF and RNYK separately reduced RGC death rates about twofold under both normal and elevated pressures. CONCLUSION: This model recapitulated the effects of elevated pressure over relatively short time periods and demonstrated the neuroprotective effects of BDNF and RNYK.


Assuntos
Glaucoma , Dispositivos Lab-On-A-Chip , Animais , Fator Neurotrófico Derivado do Encéfalo , Glaucoma/tratamento farmacológico , Pressão Intraocular , Ratos , Ratos Wistar , Células Ganglionares da Retina
11.
J Cataract Refract Surg ; 46(2): 267-275, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-32126041

RESUMO

PURPOSE: To study the effect of pupil centroid shift (PCS) compensation on lower- and higher-order aberrations (HOAs) after photorefractive keratectomy (PRK). SETTING: Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran. DESIGN: Prospective intrasubject fellow eye study. METHODS: One hundred twelve eyes of 56 patients with simple myopia or myopic astigmatism scheduled for PRK were enrolled. Preoperatively, the amount of PCS was measured in the horizontal and vertical directions. All eyes received wavefront-optimized treatment with static cyclotorsion compensation. PCS compensation was turned on for the right eye of each subject (PCS-on group), and turned off for the left eye (PCS-off group). Postoperatively, refraction and corneal HOAs were compared between the study groups at 6 months. RESULTS: Mean preoperative myopia was -3.84 diopters (D) ± 2.41 (SD) vs -3.75 ± 2.27 D (P = .408), whereas mean preoperative cylinder was -1.18 D ± 1.15 (SD) vs -1.14 ± 1.16 D (P = .769) in the PCS-on and PCS-off groups, respectively. Mean absolute PCS values were 62.25 µm ± 41.82 (SD) vs 55.92 ± 37.47 µm (P = .45) in the horizontal direction and 65.04 ± 47.16 µm vs 58.40 ± 45.44 µm in the vertical direction (P = .29) in the PCS-on and PCS-off groups, respectively. The study groups were comparable in terms of postoperative refraction and root mean square of total corneal HOAs. CONCLUSIONS: Compensation of PCS did not affect lower- and higher-order aberrations after wavefront-optimized PRK with static cyclotorsion compensation in myopic or myopic astigmatic eyes.


Assuntos
Astigmatismo/cirurgia , Aberrações de Frente de Onda da Córnea/fisiopatologia , Iris/fisiopatologia , Lasers de Excimer/uso terapêutico , Miopia/cirurgia , Ceratectomia Fotorrefrativa/métodos , Pupila/fisiologia , Adulto , Astigmatismo/fisiopatologia , Córnea/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Miopia/fisiopatologia , Estudos Prospectivos , Refração Ocular/fisiologia , Adulto Jovem
12.
J Craniofac Surg ; 31(3): e261-e263, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32011540

RESUMO

An infant with congenital 4 eyelid ectropion associated with cleft lip and palate developed exposure keratopathy. He underwent skin grafting of the upper eyelids and lateral canthal reconstruction. Ectropion and signs of exposure keratopathy improved. Congenital eyelid ectropion is a rare disorder. Surgical repair can successfully correct the condition.


Assuntos
Ectrópio/cirurgia , Doenças Palpebrais/cirurgia , Fenda Labial/cirurgia , Humanos , Recém-Nascido , Masculino , Transplante de Pele
13.
J Ophthalmic Vis Res ; 15(1): 69-77, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32095211

RESUMO

PURPOSE: To evaluate the effect of orbital steroid injections in patients with active thyroid ophthalmopathy resistant to or dependent on systemic steroids, or with complications related to systemic steroid use. METHODS: This prospective non-comparative case series includes 31 eyes of 17 patients with active thyroid ophthalmopathy and clinical activity score (CAS) of 3 or more, without compressive optic neuropathy or overt exposure keratopathy. All subjects had a history of previous systemic steroid use (with steroid resistance or dependence) or had developed complications related to steroids. A combination of steroids including triamcinolone acetonide 20 mg and dexamethasone 4 mg was injected in the upper and lower retroseptal orbital spaces three or four times at one-month intervals. The patients were examined periodically after each injection and at least three months after the last injection. RESULTS: Mean pre-injection CAS was 5.2 ± 1.3 which was improved to 1.6 ± 1 after the fourth injection (P < 0.001). Upper and lower lid retraction improved in 100% and 68.2% of the affected eyes, respectively. Strabismus completely resolved in one of five affected patients and the most significant improvement was observed in supraduction. Mean improvement in exophthalmos was 1.2 ± 1.1 mm. Visual acuity did not significantly change after the injections. Eyelid ecchymosis and/or subconjunctival hemorrhage was observed in 7.1% and intraocular pressure rise occurred in 8.8% of eyes. CONCLUSION: Orbital steroid injections can be used for the treatment of active thyroid ophthalmopathy when the patient is resistant to or dependent on systemic steroids or has developed complications of systemic steroids.

14.
Eur J Ophthalmol ; 30(3): 538-542, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-30789069

RESUMO

PURPOSE: The aim of this article is to describe the safety and efficacy of trans-iris suture fixation for the management of late dislocation of in-the-capsular-bag intraocular lenses following uncomplicated cataract surgery. PATIENTS AND METHODS: Eleven eyes of 11 patients with late in-the-capsular-bag intraocular lens dislocation following uneventful phacoemulsification cataract surgery were recruited in the study. The dislocated intraocular lens-capsular bag complex was sutured to the iris at two points 180° apart using 9-0 polypropylene sutures on long needles. RESULTS: Mean patient age was 67 ± 6 years. Seven eyes had pseudoexfoliation syndrome, one eye had Marfan syndrome, and another eye had a traumatic cataract; no risk factor was identified for intraocular lens dislocation in two eyes. A capsular tension ring had been implanted during cataract surgery in four eyes. In six eyes, the posterior chamber intraocular lenses were one-piece foldable while the remaining were three-piece intraocular lenses. Compared to the preoperative value, corrected distance visual acuity was significantly improved postoperatively (p < 0.005). Intraoperative hyphema occurred in two eyes. Pupil ovalization was observed in all eyes. Mean endothelial cell count decreased by 4 ± 1.7% after intraocular lens fixation. The capsular bag-intraocular lens complex was stable and well-centered in the pupillary area in all eyes at the final follow-up examination which was performed 16 ± 4 months postoperatively. CONCLUSION: Trans-iris fixation is a simple and effective procedure for management of late intraocular lenses-capsular bag complex dislocation, without major complications.


Assuntos
Migração do Implante de Lente Intraocular/cirurgia , Iris/cirurgia , Implante de Lente Intraocular/métodos , Complicações Pós-Operatórias , Técnicas de Sutura , Idoso , Migração do Implante de Lente Intraocular/etiologia , Catarata/etiologia , Síndrome de Exfoliação/complicações , Traumatismos Oculares/etiologia , Feminino , Seguimentos , Humanos , Pressão Intraocular/fisiologia , Cristalino/lesões , Masculino , Síndrome de Marfan/complicações , Pessoa de Meia-Idade , Facoemulsificação , Complicações Pós-Operatórias/cirurgia , Microscopia com Lâmpada de Fenda , Acuidade Visual/fisiologia
15.
Orbit ; 39(2): 107-111, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31282238

RESUMO

Purpose: To evaluate the effect of intra-lesional injection of Trichloroacetic acid (TCA) 10% in patients with conjunctival inclusion cysts.Methods: This prospective case series study included all patients with conjunctival inclusion cyst who were referred to our referral center from August 2016 to August 2018. All patients received TCA 10% injection into the conjunctival cyst, and outcomes of the intervention were evaluated at least 6 months later.Results: Ten patients with mean age of 24 ± 17.6 (range 6-65) years including three children received TCA 10% injection into the conjunctival cyst. We included 6 anophthalmic and 4 ophthalmic cases. All patients were treated successfully and no recurrence of the lesion was observed in any case. Mean follow up duration was 18.1 ± 8.3 (range 6-28) months.Conclusion: Intra-lesional injection of TCA 10% is a safe, simple, and effective treatment in patients with conjunctival inclusion cysts including ophthalmic cases and anophthalmic cases, both in adults and in children. This concentration may avoid ocular surface complications.


Assuntos
Cáusticos/uso terapêutico , Doenças da Túnica Conjuntiva/tratamento farmacológico , Cistos/tratamento farmacológico , Ácido Tricloroacético/uso terapêutico , Adolescente , Adulto , Idoso , Cáusticos/administração & dosagem , Criança , Feminino , Humanos , Injeções Intraoculares , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Ácido Tricloroacético/administração & dosagem
16.
Hum Mol Genet ; 28(21): 3637-3663, 2019 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-31518395

RESUMO

Glaucoma is a leading cause of blindness. We aimed in this study to identify genes that may make subtle and cumulative contributions to glaucoma pathogenesis. To this end, we identified molecular interactions and pathways that include transcription factors (TFs) FOXC1, PITX2, PAX6 and NFKB1 and various microRNAs including miR-204 known to have relevance to trabecular meshwork (TM) functions and/or glaucoma. TM tissue is involved in glaucoma pathogenesis. In-house microarray transcriptome results and data sources were used to identify target genes of the regulatory molecules. Bioinformatics analyses were done to filter TM and glaucoma relevant genes. These were submitted to network-creating softwares to define interactions, pathways and a network that would include the genes. The network was stringently scrutinized and minimized, then expanded by addition of microarray data and data on TF and microRNA-binding sites. Selected features of the network were confirmed by empirical studies such as dual luciferase assays, real-time PCR and western blot experiments and apoptosis assays. MYOC, WDR36, LTPBP2, RHOA, CYP1B1, OPA1, SPARC, MEIS2, PLEKHG5, RGS5, BBS5, ALDH1A1, NOMO2, CXCL6, FMNL2, ADAMTS5, CLOCK and DKK1 were among the genes included in the final network. Pathways identified included those that affect ECM properties, IOP, ciliary body functions, retinal ganglion cell viability, apoptosis, focal adhesion and oxidative stress response. The identification of many genes potentially involved in glaucoma pathology is consistent with its being a complex disease. The inclusion of several known glaucoma-related genes validates the approach used.


Assuntos
Glaucoma/genética , Adulto , Fatores de Transcrição Forkhead/genética , Fatores de Transcrição Forkhead/metabolismo , Glaucoma/metabolismo , Glaucoma/patologia , Proteínas de Homeodomínio/genética , Proteínas de Homeodomínio/metabolismo , Humanos , Masculino , MicroRNAs/genética , MicroRNAs/metabolismo , Subunidade p50 de NF-kappa B/genética , Subunidade p50 de NF-kappa B/metabolismo , Estresse Oxidativo , Fator de Transcrição PAX6/genética , Fator de Transcrição PAX6/metabolismo , Malha Trabecular/metabolismo , Fatores de Transcrição/genética , Fatores de Transcrição/metabolismo
17.
J Ophthalmic Vis Res ; 14(2): 144-150, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31114650

RESUMO

Purpose: To report the short-term outcomes of modified deep sclerectomy (MDS) in the management of open angle glaucoma. Methods: This prospective, non-randomized, controlled study included 105 eyes (105 patients) with open angle glaucoma. Eyes were categorized as follows: trabeculectomy (30 eyes), MDS (27 eyes), phacotrabeculectomy (28 eyes), and phaco-MDS (20 eyes). The MDS technique involved removal of a third scleral flap to expose the suprachoroidal space and excision of a trabecular block. A two-site approach was used for combined surgeries. Main outcome measures included intraocular pressure (IOP), number of glaucoma medications, and complications. Treatment success was defined as an IOP of 6-15 mmHg and/or a 30% reduction in IOP. Results: All groups showed significant decrease in IOP and number of medications (both P s < 0.001). The MDS group had a higher IOP (13.9 ± 3.8 vs. 12.4 ± 2.5 mmHg, P = 0.080) and required more medications (P = 0.001) than the trabeculectomy group at 1 year. The MDS group had a higher baseline IOP than the trabeculectomy group (P = 0.004) and both the groups showed similar IOP reductions (33.3% vs. 25.7%, P = 0.391). The phaco-MDS and phacotrabeculectomy groups had comparable IOP (13.3 ± 3.1 vs. 12.4 ± 3.1 mmHg, P = 0.354), number of medications (P = 0.594), and IOP reduction (P = 0.509) at 1-year follow-up visit. The trabeculectomy and phacotrabeculectomy groups developed more wound leaks (P = 0.043) and required more bleb needling during the early postoperative period (P < 0.001). Conclusion: The MDS technique seems to be slightly inferior to trabeculectomy, but when combined with phacoemulsification, is safer and results in similar IOP outcomes.

18.
J Ophthalmic Vis Res ; 14(1): 1-2, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30820279
19.
Int Ophthalmol ; 39(10): 2373-2383, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30725244

RESUMO

PURPOSE: To evaluate discrete wavelet transform coefficients and identify descriptors of pattern electroretinogram (PERG) waveforms in order to determine PERG characteristics for optimizing the diagnosis of early primary open-angle glaucoma (POAG). METHODS: Pattern electroretinogram was performed in 30 normal eyes and 30 eyes with primary open-angle glaucoma according to the ISCEV protocol. The check size was 0.8° and 16°, and the color was black/white in both groups. The results were analyzed in time domain (TD) and discrete wavelet transform (DWT) using the MATLAB software. The mean value, standard deviation, and relative energy of level 6 and 7 detail coefficients (d6, d7) and level 7 approximation coefficients (a7) of Daubechies 4 (db4), Daubechies 8 (db8), Symlet 5 (sym5), Symlet 7 (sym7), and Coiflet 5 (coif5) wavelets were calculated. In all the mentioned wavelets, DWT descriptors were extracted. Signals were reconstructed by inverse DWT. All data obtained by TD and DWT analyses were compared between the two groups. RESULTS: In both check sizes, a significant attenuation of N95 amplitude was seen in the patient group. The relative energy of a7 of db8 increased significantly in the POAG group in the 0.8° check size. In larger check stimuli, the relative energy of d7 of coif5 decreased significantly and the standard deviation of d7 of sym7 increased markedly in glaucomatous patients (P < 0.05). In small stimuli, N95 descriptor (7N) of db8 had the highest value and showed a significant increase as compared to the POAG group. In the 16° check size, there was no significant difference. A strong correlation was seen between reconstructed signals and originals (r = 0.99). CONCLUSION: The DWT can quantify PERG responses more accurately. In agreement with TD and wavelet coefficients domain results, 7N of db8 decomposition can be used as a good indicator for early detection of POAG.


Assuntos
Eletrorretinografia/métodos , Glaucoma de Ângulo Aberto/diagnóstico , Testes de Campo Visual/métodos , Adulto , Estudos de Casos e Controles , Feminino , Glaucoma de Ângulo Aberto/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Campos Visuais/fisiologia , Análise de Ondaletas , Adulto Jovem
20.
J Pediatr Ophthalmol Strabismus ; 56(1): 10-18, 2019 Jan 23.
Artigo em Inglês | MEDLINE | ID: mdl-30371913

RESUMO

PURPOSE: To describe a new surgical technique for the treatment of complete third nerve palsy. METHODS: This study included patients with chronic complete third nerve palsy. The lateral rectus muscle was split, followed by disinsertion of the superior and inferior halves, which were passed between the sclera and superior and inferior rectus muscles, respectively. Then the medial rectus muscle was sutured as posteriorly as possible from its insertion and cut. Next, the distal stump of the medial rectus muscle was split into two halves and united with the superior and inferior halves of the lateral rectus muscle. Finally, the proximal portion of the medial rectus muscle was sutured back to its original insertion. In cases with hypotropia and a functional superior oblique muscle, superior oblique tenectomy was also performed. Success was defined as postoperative horizontal deviation of 10 prism diopters (PD) or less and vertical deviation of 5 PD or less. RESULTS: Ten patients with a mean age of 32.4 ± 18.4 years had surgery using this technique; 2 of them had a history of strabismus surgery. Mean exotropia was 84 ± 14.9 PD, which reduced to 6.5 ± 8.2 PD. Mean vertical deviation was 16.5 ± 10 PD, which reduced to 2.5 ± 3.5 PD. Mean follow-up was 13.2 ± 7.9 months, and the success rate was 70% and 90% for horizontal and vertical deviations, respectively. CONCLUSIONS: The lateral rectus-medial rectus union technique is an effective and long-lasting procedure to overcome large-angle exotropia associated with complete third nerve palsy. This method can also be employed as a reoperation procedure. [J Pediatr Ophthalmol Strabismus. 2019;56(1):10-18.].


Assuntos
Movimentos Oculares/fisiologia , Músculos Oculomotores/cirurgia , Doenças do Nervo Oculomotor/cirurgia , Procedimentos Cirúrgicos Oftalmológicos/métodos , Adolescente , Adulto , Criança , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Músculos Oculomotores/fisiopatologia , Doenças do Nervo Oculomotor/fisiopatologia , Estudos Prospectivos , Resultado do Tratamento , Adulto Jovem
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