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1.
Curr Opin Ophthalmol ; 31(2): 85-90, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31922980

RESUMO

PURPOSE OF REVIEW: A process is ongoing to produce a definition of glaucomatous optic neuropathy (GON) using quantitative, objective data from structural and functional tests. At present, a common practice is to define GON by subjective features said to be 'characteristic' as judged by those experienced in glaucoma care. RECENT FINDINGS: An objective definition would standardize the comparison of clinical research results across studies, without precluding simultaneous use of idiosyncratic definitions in the same reports. To achieve this goal, expert opinion was solicited to reach optimal agreement on one or more consensus, GON definitions. An interactive period of online discussion by 176 international experts led to 110 responses in an online survey that narrowed possible definitional structures into testable criteria. SUMMARY: Two approaches to validation of one or more sets of criteria for definite and possible GON are ongoing. The general principles include definition for each eye individually, inclusion of a borderline category, no intraocular pressure criterion, and both structural and functional defects in appropriate physical locations. Each validation approach uses clinician diagnosis as a standard against which objective criteria are compared, with the initial approach using a three-level categorical scale, and the second approach using 0--100 scaling.


Assuntos
Glaucoma/diagnóstico , Doenças do Nervo Óptico/diagnóstico , Pesquisa Biomédica , Consenso , Humanos , Pressão Intraocular/fisiologia , Tonometria Ocular
2.
Zhonghua Yan Ke Za Zhi ; 56(1): 17-20, 2020 Jan 11.
Artigo em Chinês | MEDLINE | ID: mdl-31937059

RESUMO

Lamina cribrosa (LC) is considered as the original site of glaucomatous damage of axons of retinal ganglion cells, and therefore understanding the morphological changes in the LC will help to uncover the pathogenesis of glaucoma. Previous studies have indicated that the progress of glaucomatous optic neuropathy may be associated with the LC defects. Based on imaging by swept source optical coherence tomography B-Scan of the optic discs of patients with glaucoma, for the first time the spontaneous local LC defects have been found to balance the gradient between intraocular and cerebrospinal fluid pressures, which in turn can slow down the progress of glaucomatous optic neuropathy. This article provides the direct evidence supporting the role of intraocular and cerebrospinal fluid pressure gradient in the pathogenesis of glaucoma. This finding will increase our understanding of the mechanisms underlying glaucoma and help to develop novel strategies for its treatment and prognosis analysis. (Chin J Ophthalmol, 2020, 56: 17-20).


Assuntos
Glaucoma/diagnóstico , Glaucoma/fisiopatologia , Fibras Nervosas/patologia , Disco Óptico/patologia , Doenças do Nervo Óptico/diagnóstico , Células Ganglionares da Retina/patologia , Humanos , Pressão Intraocular , Tomografia de Coerência Óptica/métodos
3.
Rom J Ophthalmol ; 63(3): 222-230, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31687623

RESUMO

Objectives. Neuroprotective treatment, including citicoline, is a new perspective in glaucoma management, having the role of progression delay. The purpose of the present study was to observe the evolution of the different parameters in patients with glaucoma treated with citicoline. Methods. 22 patients with GPUD were enrolled in the study, and they received oral citicoline in addition to the ocular hypotensive therapy. Investigations were performed at the beginning of the current study, then at 3 months and 6 months, and included, besides full ophthalmologic checkup and IOP determination, optic nerve and RGCs OCT, and visual evoked potentials, pattern and flash. The data we obtained were statistically analyzed with the SPSS (Microsoft) program. Results. The outcomes of the study following VEP wave analysis indicated variations in P100 wave amplitude, but after 6 months period, an increase was found. Also, the P2 wave amplitude recorded statistically insignificant variations. The increase in P2 latency at 6 months was noted as statistically significant. Negative correlations were also met between the thickness of the RGC layer and the P100 latency, but also between the amplitude and the latency of this wave. At 6 months, a positive correlation between the RGC layer and the P100 amplitude was observed. The RNFL thickness at the optical disc had higher values at the 6 months visit, it was statistically significant, and a slight increase in the thickness of the RGC layer between successive visits was noted. These might be an examination artifact because clinically they are not possible. The RNFL thickness showed a positive correlation with the amplitude of P100 and P2 waves. Conclusions. The study of the parameters and their correlations demonstrated that citicoline had positive effects in glaucoma on certain aspects, data confirmed by literature.


Assuntos
Citidina Difosfato Colina/administração & dosagem , Glaucoma de Ângulo Aberto/tratamento farmacológico , Doenças do Nervo Óptico/prevenção & controle , Nervo Óptico/diagnóstico por imagem , Células Ganglionares da Retina/patologia , Administração Oral , Adolescente , Adulto , Idoso , Progressão da Doença , Relação Dose-Resposta a Droga , Feminino , Seguimentos , Glaucoma de Ângulo Aberto/complicações , Glaucoma de Ângulo Aberto/diagnóstico , Humanos , Pressão Intraocular/fisiologia , Masculino , Pessoa de Meia-Idade , Nootrópicos/administração & dosagem , Doenças do Nervo Óptico/diagnóstico , Doenças do Nervo Óptico/etiologia , Estudos Prospectivos , Células Ganglionares da Retina/efeitos dos fármacos , Fatores de Tempo , Tomografia de Coerência Óptica , Resultado do Tratamento , Adulto Jovem
4.
Invest Ophthalmol Vis Sci ; 60(13): 4496-4502, 2019 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-31661550

RESUMO

Purpose: To determine if variation in anterior lamina cribrosa surface depth (ALCSD) differs between glaucoma patients of African (AD) and European descent (ED). Methods: A total of 178 eyes from 123 glaucoma patients in the African Descent and Glaucoma Evaluation Study (ADAGES) and Diagnostic Innovations in Glaucoma Study (DIGS) were included. ALCSD and choroidal thickness were measured using the San Diego Automated Layer Segmentation Algorithm (SALSA). ALCSD was defined by both Bruch's membrane opening (BMO)-based (ALCSD-BMO) and scleral-based (ALCSD-Scl) reference planes. Racial differences in ALCSD were evaluated using cross-sectional univariate and multivariable models. Results: A deeper ALCSD-Scl was found in males (52.4 µm, P = 0.0401), AD individuals (78.6 µm, P = 0.0004), younger individuals (-3.1 µm/year, P < 0.0213), and eyes with larger discs (81.0 µm/mm2, P = 0.024), increased visual field loss (mean defect, MD: -6.4 µm/dB [decibel], P = 0.0106), and higher intraocular pressure (IOP: 14.1 µm/mm Hg, P = 0.0256). Significant deepening of ALSCD was observed with increasing IOP and visual field severity only in the AD group. Race modified the relationship between ALCSD-Scl and age (P = 0.0145) with ALCSD-Scl in AD individuals becoming more shallow with increasing age (-3.1 µm/year, P = 0.0213), while there was no significant association in the ED group (2.1 µm/mm Hg, P < 0.2026). Conclusions: This study demonstrates that a deeper ALCSD, regardless of the ALCSD reference plane used, is associated with more severe glaucoma and higher IOP in the ADAGES cohort, particularly in individuals of AD. These results suggest that characterizing ALCSD morphology and its relationships to IOP, aging, and glaucoma progression may help explain racial differences in disease susceptibility.


Assuntos
Grupo com Ancestrais do Continente Africano , Grupo com Ancestrais do Continente Europeu , Glaucoma de Ângulo Aberto/diagnóstico , Disco Óptico/patologia , Doenças do Nervo Óptico/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Lâmina Basilar da Corioide/diagnóstico por imagem , Lâmina Basilar da Corioide/patologia , Corioide/diagnóstico por imagem , Corioide/patologia , Estudos Transversais , Feminino , Gonioscopia , Humanos , Pressão Intraocular/fisiologia , Masculino , Pessoa de Meia-Idade , Disco Óptico/diagnóstico por imagem , Índice de Gravidade de Doença , Microscopia com Lâmpada de Fenda , Tomografia de Coerência Óptica/métodos
5.
Rinsho Shinkeigaku ; 59(11): 746-751, 2019 Nov 08.
Artigo em Japonês | MEDLINE | ID: mdl-31656266

RESUMO

We present the case of a 74-year-old woman complaining of blurred vision in the left eye who was found to have a unilateral, continuous lesion of the optic nerve and nerve sheath accompanied by an intracranial mass next to the cavernous sinus and meninges. Surgical decompression of the left optic nerve in the optic canal and partial resection of the mass followed by prednisolone administration were successful. Immunohistochemical analysis disclosed abundant infiltration of IgG4-positive plasma cells at >10 cells/high power field. These findings indicated a new pattern of compressive optic neuropathy with confirmed IgG4 histopathological findings. Such an extensive lesion may produce visual disturbance.


Assuntos
Doença Relacionada a Imunoglobulina G4/diagnóstico , Doença Relacionada a Imunoglobulina G4/terapia , Meningite/diagnóstico , Meningite/terapia , Doenças do Nervo Óptico/diagnóstico , Doenças do Nervo Óptico/terapia , Idoso , Biomarcadores/metabolismo , Seio Cavernoso/inervação , Descompressão Cirúrgica , Feminino , Glucocorticoides/administração & dosagem , Humanos , Imunoglobulina G/metabolismo , Doença Relacionada a Imunoglobulina G4/complicações , Doença Relacionada a Imunoglobulina G4/patologia , Meninges , Meningite/complicações , Meningite/patologia , Nervo Óptico/cirurgia , Doenças do Nervo Óptico/etiologia , Doenças do Nervo Óptico/patologia , Plasmócitos/metabolismo , Prednisolona/administração & dosagem , Resultado do Tratamento , Transtornos da Visão/etiologia
6.
Rinsho Shinkeigaku ; 59(10): 652-658, 2019 Oct 26.
Artigo em Japonês | MEDLINE | ID: mdl-31564705

RESUMO

A 60-year-old woman with a 3-day history of ataxic gait, blurred vision, and upper extremity paresthesia was admitted to our hospital. She presented with severe visual disturbances (finger counting), ophthalmoplegia, neck weakness, and sensory ataxia. Serum anti-GQ1b antibody, anti-GM3 antibody, and anti-GD3 antibody were strongly positive, which might contribute to the pathogenesis. Since we suspected Guillain-Barré syndrome (GBS), intravenous immunoglobulin therapy (IVIg) and high-dose steroid therapy were administered; however, improvements in her visual acuity were minimal. Additional IVIg and high-dose steroid therapy resulted in limited visual acuity improvements. Therapeutic strategies for patients with GBS and refractory optic neuropathy remain controversial.


Assuntos
Síndrome de Guillain-Barré/complicações , Síndrome de Guillain-Barré/tratamento farmacológico , Doenças do Nervo Óptico/tratamento farmacológico , Doenças do Nervo Óptico/etiologia , Autoanticorpos/sangue , Biomarcadores/sangue , Feminino , Gangliosídeo G(M3)/imunologia , Gangliosídeos/imunologia , Síndrome de Guillain-Barré/diagnóstico , Humanos , Imunoglobulinas Intravenosas/administração & dosagem , Metilprednisolona/administração & dosagem , Pessoa de Meia-Idade , Doenças do Nervo Óptico/diagnóstico , Pulsoterapia
7.
Continuum (Minneap Minn) ; 25(5): 1265-1288, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31584537

RESUMO

PURPOSE OF REVIEW: The diagnosis of visual loss from toxic-metabolic and hereditary optic neuropathies may be delayed in some cases because of a failure to elicit important information in the clinical history or to recognize typical examination findings. An understanding of the features specific to each type of toxic-metabolic and hereditary optic neuropathy, and of the underlying mechanism of insult to the optic nerve, could lead to earlier recognition, diagnosis, and treatment (when available). RECENT FINDINGS: Understanding of the role of mitochondria in toxic-metabolic and hereditary optic neuropathies is growing, particularly regarding the mechanism of insult of certain agents (medications and toxins) and of vitamin B12 deficiency. New developments in the quest for treatment for hereditary optic neuropathy, specifically Leber hereditary optic neuropathy, are being seen. SUMMARY: Toxic-metabolic and hereditary optic neuropathies present in a similar fashion, with painless, progressive, bilateral visual loss with dyschromatopsia and cecocentral visual field defects. The associated retinal ganglion cell and axonal loss is typically due to mitochondrial dysfunction caused by an exogenous agent (toxic), by insufficient or deficient substrate (metabolic or nutritional), or by abnormal proteins or mitochondrial structure determined by a genetic mutation (hereditary).


Assuntos
Atrofias Ópticas Hereditárias , Doenças do Nervo Óptico , Adulto , Humanos , Masculino , Atrofias Ópticas Hereditárias/diagnóstico , Doenças do Nervo Óptico/induzido quimicamente , Doenças do Nervo Óptico/diagnóstico , Doenças do Nervo Óptico/metabolismo , Adulto Jovem
8.
Continuum (Minneap Minn) ; 25(5): 1310-1328, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31584539

RESUMO

PURPOSE OF REVIEW: This article reviews the anatomy, symptoms, examination findings, and causes of diseases affecting the optic chiasm, optic tracts, optic radiations, and occipital lobes. RECENT FINDINGS: Modern ophthalmic imaging can be used to monitor the effects of diseases of the optic chiasm and tract on the retinal ganglion cells. It can also be used to visualize transsynaptic degeneration of the anterior visual pathway in the setting of acquired retrogeniculate lesions. Visual prostheses that directly stimulate the occipital lobe are a potential strategy for rehabilitation that is in active clinical trials. SUMMARY: Detecting and characterizing visual deficits due to optic chiasm and retrochiasmal disease are important for the diagnosis, localization, and monitoring of neurologic disease; identifying patient disability; and guiding rehabilitation.


Assuntos
Encefalopatias , Lobo Occipital , Quiasma Óptico , Doenças do Nervo Óptico , Transtornos da Visão , Vias Visuais , Adulto , Encefalopatias/diagnóstico , Encefalopatias/patologia , Encefalopatias/fisiopatologia , Encefalopatias/terapia , Feminino , Humanos , Pessoa de Meia-Idade , Lobo Occipital/patologia , Lobo Occipital/fisiopatologia , Quiasma Óptico/patologia , Quiasma Óptico/fisiopatologia , Doenças do Nervo Óptico/diagnóstico , Doenças do Nervo Óptico/patologia , Doenças do Nervo Óptico/fisiopatologia , Doenças do Nervo Óptico/terapia , Transtornos da Visão/diagnóstico , Transtornos da Visão/patologia , Transtornos da Visão/fisiopatologia , Transtornos da Visão/terapia , Vias Visuais/patologia , Vias Visuais/fisiopatologia
9.
Continuum (Minneap Minn) ; 25(5): 1401-1421, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31584543

RESUMO

PURPOSE OF REVIEW: This article discusses the varied types of paraneoplastic syndromes that commonly have neuro-ophthalmologic manifestations. Diagnostic considerations and therapeutic options for individual diseases are also discussed. RECENT FINDINGS: Paraneoplastic syndromes can affect the afferent and efferent visual systems. Paraneoplastic syndromes may result in reduced visual acuity from retinal degeneration, alterations in melanocyte proliferation and uveal thickening, or acquired nystagmus. Ocular motor abnormalities related to paraneoplastic syndromes may present with symptoms from opsoclonus or from neuromuscular junction disease. Diagnosis remains challenging, but serologic identification of some specific antibodies may be helpful or confirmatory. Treatment, in addition to directed therapies against the underlying cancer, often requires systemic corticosteroids, plasma exchange, or immunosuppression, but some specific syndromes improve with use of targeted pharmacologic therapy. SUMMARY: Diagnosis and therapy of paraneoplastic syndromes presenting with neuro-ophthalmic symptoms remain a challenge, but strategies are evolving and new approaches are on the horizon.


Assuntos
Transtornos da Motilidade Ocular/etiologia , Doenças do Nervo Óptico/etiologia , Síndrome POEMS/etiologia , Síndromes Paraneoplásicas do Sistema Nervoso/complicações , Síndromes Paraneoplásicas Oculares/complicações , Doenças Retinianas/etiologia , Transtornos da Visão/etiologia , Idoso , Feminino , Humanos , Pessoa de Meia-Idade , Transtornos da Motilidade Ocular/diagnóstico , Doenças do Nervo Óptico/diagnóstico , Síndrome POEMS/diagnóstico , Síndromes Paraneoplásicas do Sistema Nervoso/diagnóstico , Síndromes Paraneoplásicas Oculares/diagnóstico , Doenças Retinianas/diagnóstico , Transtornos da Visão/diagnóstico
10.
Middle East Afr J Ophthalmol ; 26(3): 123-126, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31619897

RESUMO

AIM: The aim of the study was to assess the role of spectral-domain optical coherence tomography (SD-OCT) as a method of choice for early glaucoma diagnosis in glaucoma suspects. DESIGN: This was a retrospective cross-sectional study. MATERIALS AND METHODS: After a comprehensive ophthalmic examination and visual field analysis, 20 patients were included in each of the three groups: Normal group, possible glaucoma, definitive glaucoma, respectively. The optic nerve head (ONH) and peripapillary retinal nerve fiber layer parameters of participants were analyzed using SD-OCT optic disc cube protocol scans. Data was analyzed using one.way analysis of variance test. RESULTS: ONH RNFL defects in possible glaucoma patients were frequently found in superior, inferior, and temporal quadrants. CONCLUSION: Diagnostic capability of SD-OCT parameters for detection of structural changes in the ONH and retinal nerve fiber layer differed in three groups significantly. Hence, using SD-OCT has become an imperative and quick way of timely diagnosis of glaucoma in private practice.


Assuntos
Glaucoma de Ângulo Aberto/diagnóstico , Fibras Nervosas/patologia , Disco Óptico/diagnóstico por imagem , Doenças do Nervo Óptico/diagnóstico , Células Ganglionares da Retina/patologia , Tomografia de Coerência Óptica/métodos , Adulto , Estudos Transversais , Diagnóstico Precoce , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Campos Visuais/fisiologia
11.
Ophthalmic Physiol Opt ; 39(6): 441-450, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31595548

RESUMO

PURPOSE: To investigate if the structure-function relationship between circumpapillary retinal nerve fibre layer (cpRNFL) thickness and visual field (VF) thresholds is stronger when using the Goldmann V target rather than the Goldman III target where glaucomatous damage is advanced. METHODS: Optical coherence tomography (OCT) and VF (Humphrey Field Analyzer 24-2 or 30-2) measurements with Goldmann III (SITA standard) and V (full-threshold) targets were carried out in 51 eyes of 51 patients with primary open angle glaucoma. The relationship between cpRNFL thicknesses in supero- and infero-temporal sectors, and VF sensitivity with the Goldmann III or V target was investigated. RESULT: Visual field sensitivities (dB) both with the Goldmann III target and Goldmann V target showed a floor effect in the structure-function relationship against cpRNFL thickness, at approximately 60 µm. There was no significant relationship between visual field sensitivity measured with the Goldmann V target (dB scale: p = 0.12, 1/Lambert scale: p = 0.40; linear mixed models) and cpRNFL thickness, when corresponding visual field sensitivity, measured with the Goldmann III target, was <20 dB. CONCLUSION: There was no improvement in the structure-function relationship using the Goldmann V target (full-threshold), compared to using the Goldmann III target (SITA standard), where glaucomatous damage was advanced.


Assuntos
Glaucoma de Ângulo Aberto/diagnóstico , Pressão Intraocular/fisiologia , Doenças do Nervo Óptico/diagnóstico , Células Ganglionares da Retina/patologia , Testes de Campo Visual/métodos , Campos Visuais/fisiologia , Idoso , Estudos Transversais , Progressão da Doença , Feminino , Glaucoma de Ângulo Aberto/complicações , Glaucoma de Ângulo Aberto/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Fibras Nervosas/patologia , Doenças do Nervo Óptico/etiologia , Reprodutibilidade dos Testes , Tomografia de Coerência Óptica/métodos
12.
Middle East Afr J Ophthalmol ; 26(2): 114-116, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31543671

RESUMO

Cysticercosis is a parasitic infection caused by the larvae of the cestode Taenia solium. Ocular parasitosis in humans is well recognized; however, cysticercosis of the optic nerve is rare. Here, we report a case of an adult male who presented with right-sided headache and a gradual loss of vision in the right eye. Optical coherence tomography indicated severe loss of ganglion cells in the right eye. Magnetic resonance imaging showed a predominantly suprasellar cystic lesion thought to represent an arachnoid cyst. We performed a craniotomy to excise the cyst. Histopathological examination of the excised cyst revealed internal living larvae of T. soilum. After co-administration of praziquantel and albendazole, vision was restored, and the headaches ceased. Vision has since been restored in both eyes. A higher degree of neurocysticercosis suspicion should be maintained for patients living in endemic areas who present with ophthalmic symptoms where the brain scans show cystic lesions.


Assuntos
Cistos Aracnóideos/diagnóstico , Cisticercose/diagnóstico , Síndromes de Compressão Nervosa/diagnóstico , Doenças do Nervo Óptico/diagnóstico , Adulto , Albendazol/uso terapêutico , Animais , Anti-Helmínticos/uso terapêutico , Cistos Aracnóideos/tratamento farmacológico , Cistos Aracnóideos/parasitologia , Cisticercose/tratamento farmacológico , Cisticercose/parasitologia , Cysticercus/isolamento & purificação , Diagnóstico Diferencial , Quimioterapia Combinada , Humanos , Imagem por Ressonância Magnética , Masculino , Síndromes de Compressão Nervosa/tratamento farmacológico , Síndromes de Compressão Nervosa/parasitologia , Doenças do Nervo Óptico/tratamento farmacológico , Doenças do Nervo Óptico/parasitologia , Praziquantel/uso terapêutico , Taenia solium/isolamento & purificação
13.
Invest Ophthalmol Vis Sci ; 60(12): 3963-3969, 2019 09 03.
Artigo em Inglês | MEDLINE | ID: mdl-31560370

RESUMO

Purpose: To investigate the optimal procedures for multichannel visually evoked potentials (VEPs) to detect misrouting in albinism subjects. Methods: Investigations were done in a phenotypically heterogeneous group of 180 albinism subjects and 187 controls with and without ocular pathology. We retrospectively compared standard flash VEP (fVEP), high-frequency fVEP with a handheld device (hh fVEP), pattern-onset VEP (poVEP), and short-onset acuity sweep VEP. The diagnostic power of these stimuli were estimated by calculating the area under the curve (AUC). Subjects were divided in three age groups (<3, 3-6 [toddler], and ≥6 years). Subjects ≥6 years of age were further divided in two visual acuity groups (≤0.3 logMAR and >0.3 logMAR). Results: The optimal stimulus was hh fVEP, standard fVEP, and poVEP 60' for subjects <3, 3-6, and ≥6 years of age, respectively. In subjects ≥6 years old with poor visual acuity, the area under the curve of fVEP was almost equal to that of poVEP 60'. Conclusions: For the optimal detection of misrouting with multichannel VEP recordings, we recommend using a high-frequency hh fVEP in children <3 years of age, standard fVEP in toddlers, and poVEP 60' in subjects ≥6 years of age. fVEP can also be used in the oldest age group for subjects with visual acuity of >0.3 logMAR. Remarkably, some albinism subjects showed misrouting on full-field stimulation but normal routing of the central retina, suggesting that not the whole line of decussation is shifted temporally.


Assuntos
Albinismo Ocular/diagnóstico , Potenciais Evocados Visuais/fisiologia , Quiasma Óptico/patologia , Doenças do Nervo Óptico/diagnóstico , Transtornos da Visão/diagnóstico , Vias Visuais/patologia , Albinismo Ocular/fisiopatologia , Área Sob a Curva , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Humanos , Masculino , Doenças do Nervo Óptico/fisiopatologia , Estimulação Luminosa , Reprodutibilidade dos Testes , Estudos Retrospectivos , Sensibilidade e Especificidade , Transtornos da Visão/fisiopatologia , Acuidade Visual
14.
Invest Ophthalmol Vis Sci ; 60(10): 3343-3351, 2019 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-31370062

RESUMO

Purpose: To determine which groupings of prognostic factors best explain the rapid progressive retinal nerve fiber layer (RNFL) thinning in patients with primary open-angle glaucoma (POAG). Methods: Optic nerves of 111 POAG patients who were followed for at least 2.5 years, during which the RNFL thickness was measured by serial spectral-domain optical coherence tomography (OCT) were included. Eyes were imaged using enhanced depth-imaging spectral-domain OCT and swept-source OCT angiography to determine the lamina cribrosa curvature index (LCCI), and the presence of a choroidal microvasculature dropout (cMvD), respectively. The rate of RNFL thinning was determined by linear regression of serial OCT RNFL thickness measurements. A regression tree model was used to find groupings of factors that best explain the rate of future RNFL thinning. Results: Disc hemorrhage, larger LCCI, and presence of cMvD were associated with faster global RNFL thinning in the multivariate regression analysis. The regression tree analysis revealed three stratified groups based on the rate of RNFL thinning, divided by the LCCI and the presence of cMvD. Eyes with LCCI ≥11.87 had the fastest RNFL thinning (-2.4 ± 0.8 µm/year, mean ± SD). Among eyes with LCCI <11.87, the presence of cMvD was the strongest factor influencing faster RNFL thinning (-1.5 ± 0.8 µm/year). Eyes with LCCI <11.87 and without a cMvD exhibited the slowest RNFL thinning (-0.8 ± 0.9 µm/year). Conclusions: Our regression tree model demonstrated that larger LCCI, and then the presence of cMvD were the first and second strongest prognostic factors for faster progressive RNFL thinning. Further studies may be needed to confirm these findings.


Assuntos
Glaucoma de Ângulo Aberto/diagnóstico , Fibras Nervosas/patologia , Disco Óptico/patologia , Doenças do Nervo Óptico/diagnóstico , Células Ganglionares da Retina/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Corioide/irrigação sanguínea , Doenças da Coroide/diagnóstico , Feminino , Gonioscopia , Humanos , Pressão Intraocular/fisiologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Tomografia de Coerência Óptica/métodos , Tonometria Ocular , Testes de Campo Visual , Campos Visuais/fisiologia , Adulto Jovem
15.
BMC Ophthalmol ; 19(1): 178, 2019 Aug 09.
Artigo em Inglês | MEDLINE | ID: mdl-31399077

RESUMO

BACKGROUND: This study is to evaluate the accuracy of machine learning for differentiation between optic neuropathies, pseudopapilledema (PPE) and normals. METHODS: Two hundred and ninety-five images of optic neuropathies, 295 images of PPE, and 779 control images were used. Pseudopapilledema was defined as follows: cases with elevated optic nerve head and blurred disc margin, with normal visual acuity (> 0.8 Snellen visual acuity), visual field, color vision, and pupillary reflex. The optic neuropathy group included cases of ischemic optic neuropathy (177), optic neuritis (48), diabetic optic neuropathy (17), papilledema (22), and retinal disorders (31). We compared four machine learning classifiers (our model, GoogleNet Inception v3, 19-layer Very Deep Convolution Network from Visual Geometry group (VGG), and 50-layer Deep Residual Learning (ResNet)). Accuracy and area under receiver operating characteristic curve (AUROC) were analyzed. RESULTS: The accuracy of machine learning classifiers ranged from 95.89 to 98.63% (our model: 95.89%, Inception V3: 96.45%, ResNet: 98.63%, and VGG: 96.80%). A high AUROC score was noted in both ResNet and VGG (0.999). CONCLUSIONS: Machine learning techniques can be combined with fundus photography as an effective approach to distinguish between PPE and elevated optic disc associated with optic neuropathies.


Assuntos
Oftalmopatias Hereditárias/diagnóstico , Aprendizado de Máquina/normas , Disco Óptico/diagnóstico por imagem , Doenças do Nervo Óptico/diagnóstico , Neurite Óptica/diagnóstico , Células Ganglionares da Retina/patologia , Acuidade Visual , Diagnóstico Diferencial , Humanos , Fibras Nervosas/patologia , Curva ROC , Reprodutibilidade dos Testes , Tomografia de Coerência Óptica/métodos
17.
Optom Vis Sci ; 96(8): 599-608, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31318797

RESUMO

SIGNIFICANCE: Causes of papilledema can be life-threatening; however, distinguishing papilledema from pseudopapilledema is often challenging. The conventional optical coherence tomography (OCT) scan for assessing the optic nerve often fails to detect mild papilledema. Our study suggests that parameters derived from volumetric OCT scans can provide additional useful information for detecting papilledema. PURPOSE: Optical coherence tomography analysis of the optic nerve commonly measures retinal nerve fiber layer thickness (RNFLT) along a 1.73-mm-radius scan path. This conventional scan, however, often fails to detect mild papilledema. The purpose of this study was to evaluate additional OCT-derived measures of the optic nerve head (ONH) and peripapillary retina for differentiating papilledema (all grades and mild) from pseudopapilledema. METHODS: Cirrus OCT ONH volume scans were acquired from 21 papilledema (15 mild papilledema), 27 pseudopapilledema, and 42 control subjects. Raw scan data were exported, and total retinal thickness within Bruch's membrane opening (BMO) plus RNFLT and total retinal thickness at the following eccentricities were calculated using custom algorithms: BMO to 250, 250 to 500, 500 to 1000, and 1000 to 1500 µm. Minimum rim width was calculated, and BMO height was measured from a 4-mm Bruch's membrane reference plane centered on the BMO. RESULTS: Retinal nerve fiber layer thickness from BMO to 250 µm, minimum rim width, and BMO height had significantly greater areas under the receiver operating characteristic curve than did conventional RNFLT for differentiating mild papilledema from pseudopapilledema (P < .0001) and greater sensitivities at 95% specificity. Using cutoff values at 95% specificity, custom parameters detected 10 mild papilledema patients, and conventional RNFLT detected only 1. Bruch's membrane opening heights above the reference plane were observed in papilledema only, although many papilledema cases had a neutral or negative BMO height. CONCLUSIONS: Using OCT volumetric data, additional parameters describing peripapillary tissue thickness, neuroretinal rim thickness, and ONH position can be calculated and provide valuable measures for differentiating mild papilledema from pseudopapilledema.


Assuntos
Oftalmopatias Hereditárias/diagnóstico , Fibras Nervosas/patologia , Doenças do Nervo Óptico/diagnóstico , Papiledema/diagnóstico , Células Ganglionares da Retina/patologia , Adulto , Lâmina Basilar da Corioide/patologia , Diagnóstico Diferencial , Feminino , Humanos , Pressão Intraocular , Masculino , Pessoa de Meia-Idade , Disco Óptico/patologia , Curva ROC , Estudos Retrospectivos , Sensibilidade e Especificidade , Tomografia de Coerência Óptica/métodos , Adulto Jovem
18.
J Binocul Vis Ocul Motil ; 69(3): 110-115, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31329056

RESUMO

Evaluating a patient with blurred optic disc margins, particularly a child, and establishing a diagnosis can be a demanding task. We aim to review the differential diagnosis of blurred disc margins, identify the clinical characteristics of a swollen optic disc, discuss imaging modalities used in the evaluation of the optic nerve head as tools for formulating a diagnosis, and identify red flags that may indicate a serious disorder.


Assuntos
Disco Óptico/patologia , Doenças do Nervo Óptico/diagnóstico , Exame Físico , Criança , Diagnóstico Diferencial , Técnicas de Diagnóstico Oftalmológico , Humanos
19.
Invest Ophthalmol Vis Sci ; 60(8): 3204-3214, 2019 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-31335946

RESUMO

Purpose: The effective management of glaucoma is hindered by an incomplete understanding of its pathologic mechanism. While important, intraocular pressure (IOP) alone is inadequate in explaining glaucoma. Non-IOP-mediated risk factors such as cerebrospinal fluid (CSF) pressure have been reported to contribute to glaucomatous optic neuropathy. Due to the difficulty associated with experimental measurement of the salient variables, such as the retrobulbar CSF pressure, porosity of the subarachnoid space (SAS), and especially those concerned with the perioptic SAS, there remains a limited understanding of the CSF behavior contributing to the translaminar pressure gradient (TLPG), hypothesized to be a critical factor in the development of glaucoma. Method: An integrated compartmental model describing the intracranial and orbital CSF dynamics, coupled with intraocular dynamics, is developed based on first principles of fluid mechanics. A sensitivity analysis is performed to identify anatomic characteristics that significantly affect the retrobulbar subarachnoid space (RSAS) pressure and, consequently, the TLPG. Results: Of the 28 parameters considered, the RSAS pressure is most sensitive to CSF flow resistance in the optic nerve SAS and the potential lymphatic outflow from the optic nerve SAS into the orbital space. A parametric study demonstrates that a combination of resistance in the range of 1.600 × 1012 - 1.930 × 1012 Pa s/m3 (200.0 - 241.3 mm Hg min/mL) with 5% to 10% lymphatic CSF outflow yields RSAS pressures that are consistent with the limited number of studies in the literature. Conclusions: The results suggest that a small percentage of lymphatic CSF outflow through the optic nerve SAS is likely. In addition, flow resistance in the orbital CSF space, hypothesized to be a function of patient-specific optic nerve SAS architecture and optic canal geometry, is a critical parameter in regulating the RSAS pressure and TLPG.


Assuntos
Glaucoma/fisiopatologia , Pressão Intracraniana/fisiologia , Pressão Intraocular/fisiologia , Doenças do Nervo Óptico/fisiopatologia , Espaço Subaracnóideo/fisiopatologia , Glaucoma/complicações , Glaucoma/diagnóstico , Humanos , Doenças do Nervo Óptico/diagnóstico , Doenças do Nervo Óptico/etiologia , Espaço Subaracnóideo/diagnóstico por imagem , Tonometria Ocular
20.
Indian J Ophthalmol ; 67(7): 1210-1212, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31238469

RESUMO

Tuberculous optic neuropathy that includes papillitis, neuroretinitis, and optic nerve tubercle is a rare presentation of ocular tuberculosis. Though contagious spread from choroid following the hematogenous dissemination of the bacilli has been implicated in the optic nerve involvement, unlike neuroretinitis, optic nerve and choroidal involvement are usually considered as two separate clinical entities. We report a case of optic nerve involvement in a 33-year-old male who had concurrent choroidal involvement at present and also in the past. A strong history of contact with patients of pulmonary tuberculosis, positive tuberculin skin test, interferon gamma release assay, and high-resolution computed tomography helped us to clinch the diagnosis. Patients responded to systemic corticosteroid therapy and anti-tuberculosis treatment. Choroidal involvement in a case of inflammatory optic neuropathy should arise suspicion of tuberculous etiology.


Assuntos
Corioidite/complicações , Infecções Oculares Bacterianas/complicações , Disco Óptico/patologia , Doenças do Nervo Óptico/etiologia , Tuberculose Ocular/complicações , Adulto , Corioidite/diagnóstico , Infecções Oculares Bacterianas/diagnóstico , Angiofluoresceinografia , Fundo de Olho , Humanos , Masculino , Doenças do Nervo Óptico/diagnóstico , Tuberculose Ocular/diagnóstico , Acuidade Visual
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