Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 1.559
Filtrar
1.
Medicine (Baltimore) ; 99(31): e21467, 2020 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-32756168

RESUMO

BACKGROUND: This study aimed to evaluate the scleral thickness and corneal parameters of patients with systemic lupus erythematosus (SLE). METHODS: Forty-seven eyes of 47 SLE patients and 44 eyes of healthy controls were included in this cross-sectional study. Anterior segment optical coherence tomography (AS-OCT) was used to measure the corneal and scleral thickness. Scleral thickness (ST) was measured based upon the segmentation at 1000 to 5000 µm from the scleral spur. Pentacam HR was used to measure corneal parameters. RESULTS: There was no statistically significant difference between SLE group and control group according to age and sex (P > .05). The ST measurements at all distances from scleral spur were found to be thicker in patients with SLE (P < .05). Central corneal thickness (CCT), cornea volume (CV), corneal densitometry (CD), and peripheral corneal thickness (PCT) measurements were similar between the groups (P > .05). CONCLUSION: ST was thicker in SLE patients compared with healthy controls. AS-OCT seems helpful in selecting optimal sites for pharmaceutical or surgical intervention in SLE patients, since it shows thickness variations in anterior sclera.


Assuntos
Córnea/diagnóstico por imagem , Lúpus Eritematoso Sistêmico/complicações , Esclera/diagnóstico por imagem , Tomografia de Coerência Óptica/métodos , Adulto , Estudos de Casos e Controles , Córnea/patologia , Paquimetria Corneana/métodos , Estudos Transversais , Densitometria , Feminino , Voluntários Saudáveis , Humanos , Lúpus Eritematoso Sistêmico/patologia , Masculino , Pessoa de Meia-Idade , Esclera/patologia , Turquia/epidemiologia
3.
Am J Pathol ; 190(9): 1888-1908, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32553806

RESUMO

Myopia is a leading cause of visual impairment worldwide. This sight-compromising condition is associated with scleral thinning, extracellular matrix remodeling, and inappropriate optical axial length elongation. Although macrophages are present in the sclera, their involvement in this condition is unknown. By using a form-deprivation myopia (FDM) mouse model, we found that both the scleral macrophage density and their matrix metalloproteinase-2 (MMP-2) expression levels increased in myopic eyes. Partial scleral macrophage depletion by clodronate shifted the refraction toward hyperopia in both the form-deprived and the untreated fellow eyes compared with their respective counterparts in the vehicle-injected control mice. However, this procedure did not alter susceptibility to FDM. FDM development was 59% less in the macrophage-specific Mmp2 deletion (LysMCreMmp-2fl/fl) mice than in their Cre-negative littermates (Mmp2fl/fl mice). Moreover, the expression of scleral C-C motif chemokine ligand-2 (CCL2), which is a potent monocyte chemoattractant recruiting monocytes to tissue sites, was increased during myopia progression. However, the increase in the density of scleral macrophages and myopia development were suppressed in fibroblast-specific Ccl2 deletion mice. These declines suggested that the increase in scleral macrophage density in myopic eyes stems from the up-regulation of scleral Ccl2 expression in fibroblasts, which, in turn, promotes monocytes recruitment. In summary, scleral monocyte-derived macrophages contribute to myopia development through enhancing MMP-2 expression in mice.


Assuntos
Macrófagos/enzimologia , Metaloproteinase 2 da Matriz/metabolismo , Miopia/enzimologia , Esclera/enzimologia , Esclera/patologia , Animais , Macrófagos/patologia , Camundongos , Camundongos Endogâmicos C57BL , Miopia/patologia , Regulação para Cima
4.
Sci Rep ; 10(1): 8203, 2020 05 18.
Artigo em Inglês | MEDLINE | ID: mdl-32424225

RESUMO

In meta-analyses, it has been reported that myopia is a risk factor for glaucoma and there is increasing evidence that autonomic dysfunction causing vascular dysregulation or perfusion dysfunction is considered an important factor in the progression of glaucoma. There have been experimental studies to find out the association between autonomic nervous system and ocular growth, but no clinical study yet has evaluated the relationship between them. Therefore, we enrolled 208 open angle glaucoma patients and measured heart-rate-variability(HRV). We used the standard deviation value of the qualified normal to normal intervals (SDNN) parameter of HRV, which is considered an autonomic influence index and characterized the total effect of the regulation of autonomic blood circulation. Patients were classified into the two groups according to SDNN: those with low possibility of autonomic dysfunction (LoAD group) and those with high possibility of autonomic dysfunction (HiAD group). We evaluated myopic features employing a 'posterior scleral profile' identified by the disc tilt ratio, disc torsion, fovea-BMO center (FoBMO) angle and peripapapillary area(PPA) to disc ratio. HiAD group showed higher values than LoAD group in posterior scleral deformation profile such like axial length, disc tilt, torsion degree. We suggest the possibility of association between myopic deformation and autonomic dysfunction.


Assuntos
Sistema Nervoso Autônomo/fisiopatologia , Glaucoma/patologia , Glaucoma/fisiopatologia , Esclera/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
5.
Am J Ophthalmol ; 217: 287-296, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32387433

RESUMO

PURPOSE: To investigate the structural characteristics of the posterior sclera around the optic nerve head (ONH) in patients with normal-tension glaucoma (NTG) and myopia with central visual field (VF) defect. DESIGN: Cross-sectional study. METHODS: Ninety-seven eyes of 97 NTG patients with myopia were included in this study. Swedish interactive thresholding algorithm (SITA) 24-2 and 10-2 were both performed to compare the central VF with peripheral VF. Optic disc torsion, tilt, and peripapillary atrophy area were calculated in 2-dimensional disc photographs. The most posterior point-that is, the deepest point of the eye (DPE)-was identified in 3-dimensional en face optical coherence tomography results and related measurements were calculated using built-in software. RESULTS: Forty-two eyes had worse SITA 10-2 mean deviation (MD) than SITA 24-2 MD and they were assigned to the central dominant VF defect group. The central dominant VF defect group had larger disc torsion and ONH tilt angle and shallower disc-DPE depth than the peripheral dominant VF defect group. According to logistic regression analysis, large ONH tilt angle and shallow disc-DPE depth were significant factors associated with central visual function impairment. CONCLUSIONS: Subjects with worse central VF than peripheral showed greater peripapillary scleral deformation, such as in torsion and tilt. Their posterior scleral deformation appeared to be closer to the ONH. Scleral deformation around the ONH may be associated with papillomacular bundle and central VF defects.


Assuntos
Pressão Intraocular/fisiologia , Glaucoma de Baixa Tensão/fisiopatologia , Miopia/fisiopatologia , Disco Óptico/patologia , Esclera/patologia , Tomografia de Coerência Óptica/métodos , Campos Visuais/fisiologia , Estudos Transversais , Feminino , Seguimentos , Humanos , Glaucoma de Baixa Tensão/diagnóstico , Masculino , Pessoa de Meia-Idade , Miopia/diagnóstico , Estudos Retrospectivos
7.
Am J Ophthalmol ; 218: 105-119, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32445702

RESUMO

PURPOSE: To measure the magnitude and direction of anterior scleral canal opening (ASCO) offset relative to the Bruch membrane opening (BMO) (ASCO/BMO offset) to characterize neural canal obliqueness and minimum cross-sectional area (NCMCA) in 69 highly myopic and 138 healthy, age-matched, control eyes. DESIGN: Cross-sectional study. METHODS: Using optical coherence tomography (OCT) scans of the optic nerve head (ONH), BMO and ASCO were manually segmented and their centroids and size and shape were calculated. ASCO/BMO offset magnitude and direction were measured after projecting the ASCO/BMO centroid vector onto the BMO plane. Neural canal axis obliqueness was defined as the angle between the ASCO/BMO centroid vector and the vector perpendicular to the BMO plane. NCMCA was defined by projecting BMO and ASCO points onto a plane perpendicular to the neural canal axis and measuring their overlapping area. RESULTS: ASCO/BMO offset magnitude was greater (highly myopic eyes 264.3 ± 131.1 µm; healthy control subjects 89.0 ± 55.8 µm, P < .001, t test) and ASCO centroid was most frequently nasal relative to BMO centroid (94.2% of eyes) in the highly myopic eyes. BMO and ASCO areas were significantly larger (P < .001, t test), NCMCA was significantly smaller (P < .001), and all 3 were significantly more elliptical (P ≤ .001) in myopic eyes. Neural canal obliqueness was greater in myopic (65.17° ± 14.03°) compared with control eyes (40.91° ± 16.22°; P < .001, t test). CONCLUSIONS: Our data suggest that increased temporal displacement of BMO relative to the ASCO, increased BMO and ASCO area, decreased NCMCA, and increased neural canal obliqueness are characteristic components of ONH morphology in highly myopic eyes.


Assuntos
Segmento Anterior do Olho/patologia , Lâmina Basilar da Corioide/patologia , Miopia Degenerativa/patologia , Disco Óptico/patologia , Esclera/patologia , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Miopia Degenerativa/diagnóstico por imagem , Disco Óptico/diagnóstico por imagem , Tomografia de Coerência Óptica
8.
Invest Ophthalmol Vis Sci ; 61(4): 41, 2020 04 09.
Artigo em Inglês | MEDLINE | ID: mdl-32343781

RESUMO

Purpose: To measure the ex vivo pressure-induced strain response of the human optic nerve head and analyze for variations with glaucoma diagnosis and optic nerve axon damage. Methods: The posterior sclera of 16 eyes from 8 diagnosed glaucoma donors and 10 eyes from 6 donors with no history of glaucoma were inflation tested between 5 and 45 mm Hg. The optic nerve from each donor was examined for degree of axon loss. The posterior volume of the lamina cribrosa (LC) was imaged with second harmonic generation and analyzed using volume correlation to calculate LC strains between 5 and 10 and 5 and 45 mm Hg. Results: Eye length and LC area were larger in eyes diagnosed with glaucoma (P ≤ 0.03). Nasal-temporal EXX and circumferential Eθθ strains were lower in the LC of diagnosed glaucoma eyes at 10 mm Hg (P ≤ 0.05) and 45 mm Hg (P ≤ 0.07). EXX was smaller in the LC of glaucoma eyes with <25% axon loss compared with undamaged normal eyes (P = 0.01, 45 mm Hg). In general, the strains were larger in the peripheral than central LC. The ratio of the maximum principal strain Emax in the peripheral to central LC was larger in glaucoma eyes with >25% axon loss than in glaucoma eyes with milder damage (P = 0.004, 10 mm Hg). Conclusions: The stiffness of the LC pressure-strain response was greater in diagnosed glaucoma eyes and varied with glaucomatous axon damage. Lower LC strains in glaucoma eyes with milder damage may represent baseline biomechanical behavior that contributes to axon loss, whereas greater LC strain and altered radial LC strain variation in glaucoma eyes with more severe damage may be caused by glaucoma-related remodeling.


Assuntos
Glaucoma/diagnóstico por imagem , Glaucoma/fisiopatologia , Imageamento Tridimensional , Disco Óptico/diagnóstico por imagem , Disco Óptico/patologia , Estresse Mecânico , Idoso , Idoso de 80 Anos ou mais , Fenômenos Biomecânicos , Estudos de Casos e Controles , Feminino , Humanos , Técnicas In Vitro , Masculino , Valores de Referência , Esclera/diagnóstico por imagem , Esclera/patologia , Manejo de Espécimes
9.
Invest Ophthalmol Vis Sci ; 61(4): 6, 2020 04 09.
Artigo em Inglês | MEDLINE | ID: mdl-32271887

RESUMO

Purpose: Considering that ocular expansion is associated with scleral thinning, this study investigated variation in scleral thickness (anterior scleral thickness [AST] and posterior scleral thickness [PST]) in different meridians across emmetropes and a wide range of myopes. Methods: A total of 95 participants (mean age, 24 ± 4 years) including emmetropes (spherical equivalent refractive error, ±0.75 diopters [D]; n = 20) and myopes (-1.00 to -27.25 D; n = 75) underwent ocular imaging with swept-source optical coherence tomography. All the images were analyzed using semiautomated custom-designed software to determine scleral thickness in 1-mm intervals. AST was estimated from limbus to 5 mm (n = 95), and PST from fovea to 5 mm (n = 25; high myopes only) along the horizontal and vertical meridian. Results: The median spherical equivalent refractive error and axial length were -4.25 D (IQR, -12.50 to -1.00 D) and 25 mm (IQR, 23.72-28.35 mm), respectively. The anterior sclera was thinnest in the superior and thickest in the inferior region (475.3 ± 19.0 vs. 605.9 ± 18.6 µm; P < 0.001). The inferior AST alone decreased significantly with increasing magnitude of myopia (r = 0.27; P = 0.008). There were no differences in AST between nasal and temporal meridians (583.24 ± 15.00 vs. 587.09 ± 27.00 µm; P > 0.05). The mean subfoveal PST for the subset of high myopes was 251.7 ± 12.0 µm which was thinner than mean AST along all the meridians by more than 45%. The averaged scleral thickness peripheral to fovea (1-5 mm) was similar along different meridians (P > 0.05). Conclusions: The relative significant thinning of the anterior sclera along the inferior meridian with increasing degree of myopia compared with the other three meridians indicates the potential role of AST, especially in the inferior meridian, to act as a marker for myopia progression.


Assuntos
Segmento Anterior do Olho/patologia , Miopia/fisiopatologia , Esclera/patologia , Adolescente , Adulto , Segmento Anterior do Olho/diagnóstico por imagem , Comprimento Axial do Olho , Emetropia , Feminino , Humanos , Masculino , Miopia/diagnóstico por imagem , Tamanho do Órgão , Esclera/diagnóstico por imagem , Tomografia de Coerência Óptica , Adulto Jovem
10.
J Fr Ophtalmol ; 43(4): 312-318, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32115270

RESUMO

PURPOSE: A certain number of conditions can result in compromised anterior and/or posterior capsular integrity. Several surgical options have been employed for repositioning dislocated intraocular lenses in the absence of adequate capsular support. The purpose of this study is to assess the functional outcomes and complication profile of a modified surgical technique for replacing dislocated intraocular lenses. MATERIAL AND METHODS: All patients who had undergone the modified surgical procedure for dislocated intraocular lenses between 2012 and 2017 were retrospectively reviewed for visual outcomes and complications. Patient demographic characteristics, pre- and postoperative visual acuity, surgical indications, refractive outcomes, intraocular pressure and postoperative complications were recorded and analysed at baseline and at six months, which was the conclusion of the study. We also present our modified surgical technique. RESULTS: Sixty-eight eyes of sixty-eight patients (74% male) were included. Mean age at surgery was 58 years (range 4-89 years). Mean best-corrected visual acuity increased significantly from 0.80 (SD±0.2) LogMar to 0.40 (SD±0.1) LogMar (P<0.005). Median astigmatic error at the conclusion of follow-up remained stable. There were no intraoperative complications and a low postoperative complication rate (10.2%), mainly related to the surgical context. CONCLUSION: Sutureless intrascleral fixation of dislocated intraocular lenses is an option in case of deficient capsular support. Visual outcomes and complication rates are comparable to other case series.


Assuntos
Implante de Lente Intraocular/métodos , Lentes Intraoculares , Esclera/cirurgia , Técnicas de Sutura , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Afacia Pós-Catarata/cirurgia , Criança , Pré-Escolar , Feminino , Humanos , Implante de Lente Intraocular/efeitos adversos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Esclera/patologia , Técnicas de Sutura/efeitos adversos , Resultado do Tratamento , Acuidade Visual , Adulto Jovem
12.
J Glaucoma ; 29(6): 423-428, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32205833

RESUMO

PURPOSE: To compare disease severity between preperimetric primary open-angle glaucoma (POAG) patients with and without deep-layer microvasculature dropout. MATERIALS AND METHODS: Ninety-four eyes of 94 preperimetric POAG patients with ß-zone parapapillary atrophy (ßPPA) were categorized according to the presence of deep-layer microvasculature dropout defined as a complete loss of microvasculature within the choroid or scleral flange on optical coherence tomography angiography. Parameters representing disease severity, that is, visual field (VF) mean deviation (MD), global and sectoral (6-sector) retinal nerve fiber layer (RNFL) thickness, and other factors including age, focal lamina cribrosa (LC) defect, width of ßPPA with and without Bruch membrane (BM) (ßPPA+BM and ßPPA-BM), and optic disc hemorrhage were compared between eyes with and without dropout. RESULTS: Deep-layer microvasculature dropout was observed in 33 preperimetric POAG eyes (35.1%). Eyes with dropout had significantly thinner RNFL in all areas except the inferonasal sector, worse VF MD, and higher prevalence of focal LC defect, and larger ßPPA-BM (P<0.05), whereas the 2 groups did not differ in age, disc hemorrhage, or ßPPA+BM width (P>0.05). In the multivariable logistic regression, worse VF MD [odds ratio (OR), 1.485; P=0.045], thinner RNFL (OR, 1.141; P<0.001), and higher prevalence of focal LC defect (OR, 6.673; P<0.001) were significantly associated with dropout. CONCLUSIONS: Deep-layer microvasculature dropout was observed in a considerable number of preperimetric POAG eyes, and worse disease severity was associated with dropout. Future studies elucidating the pathogenic role of deep-layer microvasculature dropout in the development and progression of glaucoma are warranted.


Assuntos
Glaucoma de Ângulo Aberto/complicações , Glaucoma de Ângulo Aberto/patologia , Microvasos/patologia , Doenças do Nervo Óptico/complicações , Adulto , Idoso , Corioide/irrigação sanguínea , Corioide/patologia , Estudos de Coortes , Progressão da Doença , Feminino , Glaucoma de Ângulo Aberto/diagnóstico por imagem , Humanos , Pressão Intraocular , Masculino , Microvasos/diagnóstico por imagem , Pessoa de Meia-Idade , Disco Óptico/irrigação sanguínea , Disco Óptico/patologia , Doenças do Nervo Óptico/diagnóstico por imagem , Doenças do Nervo Óptico/patologia , Esclera/irrigação sanguínea , Esclera/patologia , Índice de Gravidade de Doença , Tomografia de Coerência Óptica/métodos , Campos Visuais
13.
PLoS One ; 15(3): e0216970, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32119664

RESUMO

Jaundice is a major cause of mortality and morbidity in the newborn. Globally, early identification and home monitoring are significant challenges in reducing the incidence of jaundice-related neurological damage. Smartphone cameras are promising as colour-based screening tools as they are low-cost, objective and ubiquitous. We propose a novel smartphone method to screen for neonatal jaundice by imaging the sclera. It does not rely on colour calibration cards or accessories, which may facilitate its adoption at scale and in less economically developed regions. Our approach is to explicitly address three confounding factors in relating colour to jaundice: (1) skin pigmentation, (2) ambient light, and (3) camera spectral response. (1) The variation in skin pigmentation is avoided by imaging the sclera. (2) With the smartphone screen acting as an illuminating flash, a flash/ no-flash image pair is captured using the front-facing camera. The contribution of ambient light is subtracted. (3) In principle, this permits a device- and ambient-independent measure of sclera chromaticity following a one-time calibration. We introduce the concept of Scleral-Conjunctival Bilirubin (SCB), in analogy with Transcutaneous Bilirubin (TcB). The scleral chromaticity is mapped to an SCB value. A pilot study was conducted in the UCL Hospital Neonatal Care Unit (n = 37). Neonates were imaged using a specially developed app concurrently with having a blood test for total serum bilirubin (TSB). The better of two models for SCB based on ambient-subtracted sclera chromaticity achieved r = 0.75 (p<0.01) correlation with TSB. Ambient subtraction improved chromaticity estimates in proof-of-principle laboratory tests and screening performance within our study sample. Using an SCB decision threshold of 190µmol/L, the sensitivity was 100% (specificity 61%) in identifying newborns with TSB>250µmol/L (area under receiver operating characteristic curve, AUROC, 0.86), and 92% (specificity 67%) in identifying newborns with TSB>205µmol/L (AUROC 0.85). These results are comparable to modern transcutaneous bilirubinometers.


Assuntos
Icterícia Neonatal/diagnóstico , Triagem Neonatal , Esclera/patologia , Smartphone , Bilirrubina/metabolismo , Cor , Túnica Conjuntiva/metabolismo , Feminino , Humanos , Recém-Nascido , Masculino , Curva ROC
14.
J Glaucoma ; 29(6): 473-478, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32102033

RESUMO

PRECIS: This clinical trial compares a modified trabeculectomy technique [extended subscleral tunnel (ESST)] with conventional trabeculectomy [subscleral trabeculectomy (SST)] in terms of success rate and bleb morphology. ESST showed comparable results, with lower incidence of bleb-related complications and need for postoperative antiglaucoma medications. BACKGROUND: To evaluate the outcome of modified trabeculectomy with extended subscleral tunnel "ESST" versus conventional subscleral trabeculectomy "SST" in the management of uncontrolled primary open-angle glaucoma. PARTICIPANTS AND METHODS: This is a randomized clinical trial of 40 eyes (40 patients) divided into 2 equal groups. In the first group, a conventional SST with adjuvant 0.3% mitomycin-C was performed. In the second group, the ESST group, an additional 1.00 mm wide longitudinal scleral groove was dissected and excised in the center of the deep scleral bed extending 1.00 mm beyond the posterior margin of the flap. Patients were examined on days 1, 7, 14, 30, 90, 180, and at 1 year, with a special focus on intraocular pressure and bleb morphology. Postoperative ultrasound biomicroscopy was performed to evaluate the surgical area. RESULTS: Both groups showed a significant reduction in intraocular pressure, with the ESST group showing significantly lower values on days 7, 14, 30, 90, and 180 (P=0.001, 0.004, 0.026, 0.001, and 0.048), but no significant differences on day 1 and at 1 year (P=0.06 and 0.07). The need for postoperative antiglaucoma medications was significantly lower in the ESST group (P=0.043). Visually significant cataract and bleb related complications were more in the SST group (P=0.044 and <0.001). Significantly more eyes in the ESST group showed normal bleb vascularity and wider extent. CONCLUSIONS: ESST offers a guarded posterior flow with a success rate comparable to that of conventional SST. ESST could minimize bleb-related complications and bleb-dysesthesia with better long-term bleb morphology and vascularity. It could also minimize the need for further adjuvant postoperative antiglaucoma medications.


Assuntos
Glaucoma de Ângulo Aberto/cirurgia , Esclera/cirurgia , Trabeculectomia/efeitos adversos , Trabeculectomia/métodos , Adulto , Idoso , Anti-Hipertensivos/administração & dosagem , Vesícula/diagnóstico , Vesícula/tratamento farmacológico , Vesícula/etiologia , Feminino , Glaucoma de Ângulo Aberto/diagnóstico , Glaucoma de Ângulo Aberto/tratamento farmacológico , Glaucoma de Ângulo Aberto/fisiopatologia , Humanos , Pressão Intraocular/efeitos dos fármacos , Masculino , Microscopia Acústica , Pessoa de Meia-Idade , Mitomicina/administração & dosagem , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/tratamento farmacológico , Estudos Prospectivos , Esclera/diagnóstico por imagem , Esclera/patologia , Retalhos Cirúrgicos , Fatores de Tempo , Tonometria Ocular
15.
Invest Ophthalmol Vis Sci ; 61(2): 40, 2020 02 07.
Artigo em Inglês | MEDLINE | ID: mdl-32097477

RESUMO

Purpose: To determine the relationship between funduscopic findings in myopic eyes and the prevalence and structure of the conus in the optical coherence tomographic (OCT) images. Methods: A prospective observational cross-sectional study of 121 right eyes of 121 young healthy volunteers. All participants underwent color fundus photography (CFP), scanning laser ophthalmoscopy, and OCT. Based on the OCT analyses, the area between the edge of the ellipsoid zone (EZ) and that of choroid was defined as the "choroidal conus (CC)", and the area between the edge of the choroid and the scleral edge as the "scleral conus (SC)". The eyes were classified into three groups such as the non-conus (NC) group, CC group, and SC group. The differences in the axial length, optic disc tilt, ovality ratio, papillomacular position angle, and peripapillary nerve fiber elevation (pNFE) between the three groups were determined. Results: CFPs detected a conus in 79 eyes (65.3 %). The outer border of the conus in CFPs corresponded with the edge of the EZ in the OCT in all subjects. Thirty-seven eyes had CC alone (CC group) and 42 eyes had both CC and SC (SC group). The CC and SC groups had longer axial lengths and more frequent pNFEs than the NC group. There was a significant difference in the optic disc tilt and ovality ratio between the CC and SC groups. Conclusions: The eyes with SC tend to have larger optic disc tilt and smaller ovality ratio than the eyes with CC only.


Assuntos
Miopia/patologia , Disco Óptico/patologia , Esclera/patologia , Adulto , Estudos Transversais , Humanos , Masculino , Oftalmoscopia/métodos , Estudos Prospectivos , Tomografia de Coerência Óptica/métodos , Adulto Jovem
16.
J Fr Ophtalmol ; 43(3): 228-236, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31987680

RESUMO

PURPOSE: Two of the hurdles that are facing ophthalmologists in developing countries are scarcity of resources and patient follow-up. Deep sclerectomy (DS) has proven less costly and more effective than topical therapies and has a more favorable safety profile than trabeculectomy. The main factors preventing its use in developing countries are the need to perform laser goniopuncture in 40-80% of cases to maintain filtration and the risk of postoperative iris incarceration. The purpose of this study is to assess the efficacy and safety profile in advanced open-angle glaucoma of a relatively new surgical technique designed to overcome this limitation: penetrating DS. SETTING: This was an investigator-initiated, prospective, interventional study, conducted at a single ophthalmology center in Kinshasa, Congo. The study was conducted in full compliance with the Declaration of Helsinki. METHODS: Fifty-one eyes (34 patients) with uncontrolled advanced primary open-angle glaucoma (visual field mean deviation<-10 dBs) were enrolled between October 2012 and June 2016. Age, gender, comorbidities (hypertension/diabetes), best-corrected visual acuity, topical medications, medicated and unmedicated intraocular pressure (IOP) were recorded. All patients underwent penetrating DS, during which, following standard dissection of the scleral flaps, the anterior chamber was penetrated through the trabeculo-Descemet membrane and an iridectomy was performed. Patients attended postoperative appointments at months 1, 3, 6 and 12. Surgical success was defined as a 20% reduction of IOP from baseline in conjunction with a 12-month unmedicated IOP≤12mmHg. RESULTS: The mean age was 64.5±14.0 years (44.1% female, 100% African). Mean IOP decreased from 20.2±6.1 (medicated) and 30.7±9.8mmHg (unmedicated) preoperatively to 12.1±4.1 at 12 months. Concomitantly, the number of topical medications decreased from 1.5±0.7 to 0.0. Complete surgical success was achieved in 64.7%. Four eyes (7.8%) were considered surgical failures due to uncontrolled IOP. None of the eyes lost light perception or required additional surgery. A significant association between surgical failure and hypertension was observed (HR=1.49; P=0.008). There were no intraoperative complications. Postoperatively, 4 bleb encapsulations (7.8%) and 1 iris incarceration (2%) were observed. CONCLUSIONS: The present study demonstrates that penetrating DS achieved similar efficacy and safety results to traditional non-penetrating DS. In addition, it showed a lower potential for intraoperative complications, which might be associated with a more benign surgical learning curve. Finally, the rates of serious postoperative complications (iris incarceration, choroidal effusion and hypotony) were significantly lower than in DS and trabeculectomy, and this technique does not require subsequent Nd: YAG laser goniopuncture to maintain filtration, making frequent follow-up visits less critical. In view of these findings, perforating deep sclerectomy could offer a viable option for glaucoma management in developing countries as well as worldwide.


Assuntos
Glaucoma de Ângulo Aberto/cirurgia , Esclerostomia/métodos , Idoso , República Democrática do Congo , Países em Desenvolvimento , Progressão da Doença , Feminino , Cirurgia Filtrante/economia , Cirurgia Filtrante/métodos , Seguimentos , Glaucoma de Ângulo Aberto/economia , Glaucoma de Ângulo Aberto/patologia , Humanos , Pressão Intraocular , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Pobreza/economia , Esclera/patologia , Esclera/cirurgia , Esclerostomia/efeitos adversos , Esclerostomia/economia , Trabeculectomia/efeitos adversos , Trabeculectomia/economia , Trabeculectomia/métodos
17.
Acta Ophthalmol ; 98(1): e43-e49, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31421014

RESUMO

PURPOSE: To assess dimensions and associations of the peripapillary border tissue of the choroid (PBT-C) and peripapillary scleral flange (PBT-S). METHODS: The histomorphometric investigation included histological sections of enucleated eyes of Caucasian patients. Using light microscopy, the PBT dimensions were measured. RESULTS: The study included 85 eyes (85 patients) with an age of 62.0 years (14.1 years) (mean (SD)) (range:37-87 years) and mean axial length of 26.7 mm (3.5 mm) (range:21.0-37.0 mm). Thicker PBT-C thickness (mean: 68.8 µm (35.7 µm)) was associated with shorter axial length (p < 0.001; standardized regression coefficient beta: -0.50), and longer PBT-C length (mean: 531 µm (802 µm)) was correlated with longer axial length (p < 0.001;beta:0.66). PBT-C cross-sectional area (mean 17 050 µm2 (10 420 µm2 )) was not significantly associated with axial length (p = 0.37). Decreasing with longer axial length (p < 0.001;beta:0.64), the angle between PBT-C and Bruch's membrane was approximately 90° in non-highly myopic eyes without overhanging Bruch's membrane (BM), it ranged between 100° and 180° in eyes with BM overhanging into the intrapapillary region, and it was close to 0° in eyes with parapapillary gamma zone. Thicker thickness of PBT-S (mean:83 µm (21 µm)) was correlated with presence of glaucoma (p = 0.02). Optic nerve pia mater thickness (mean:109 µm (44 µm)) increased with glaucoma presence (p = 0.046;beta:0.31) but not with axial length (p = 0.34). CONCLUSIONS: Peripapillary border tissue of the choroid (PBT-C) and PBT-S as continuation of the optic nerve pia mater are distinct structures, with PBT-C remodelling during myopic axial elongation and PBT-S being mostly independent of axial elongation. PBT-C and PBT-S may be of importance for the optic nerve head biomechanics and PBT-C for separation of the choroidal space from the intrapapillary compartment.


Assuntos
Comprimento Axial do Olho/patologia , Corioide/patologia , Glaucoma/diagnóstico , Miopia Degenerativa/diagnóstico , Disco Óptico/patologia , Esclera/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Lâmina Basilar da Corioide/patologia , Enucleação Ocular , Feminino , Glaucoma/fisiopatologia , Humanos , Pressão Intraocular , Masculino , Pessoa de Meia-Idade , Miopia Degenerativa/fisiopatologia
18.
Indian J Ophthalmol ; 68(1): 229-231, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31856534

RESUMO

Corneoscleral tunnel infection is a potentially sight threatening complication of cataract surgery. Microbiological investigations are mandatory and early surgical intervention helps in achieving favourable outcomes. Fungal infection of tunnel incisions can pose a diagnostic and therapeutic challenge. We report a case of post-operative tunnel infection with curvularia. Prompt surgical intervention and intensive topical therapy helped attain a good tectonic as well as visual recovery.


Assuntos
Córnea/cirurgia , Infecções Oculares Bacterianas/diagnóstico , Facoemulsificação/efeitos adversos , Esclera/cirurgia , Infecção da Ferida Cirúrgica/diagnóstico , Idoso de 80 Anos ou mais , Córnea/patologia , Infecções Oculares Bacterianas/microbiologia , Feminino , Humanos , Esclera/patologia , Infecção da Ferida Cirúrgica/microbiologia , Acuidade Visual
20.
J Fr Ophtalmol ; 43(1): e1-e5, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31836294

RESUMO

PURPOSE: To assess visual improvement in patients with pellucid marginal degeneration (PMD) after fitting with SPOT® scleral contact lenses (Scleral Protection & Ocular Treatment, Laboratoires d'Appareillage Oculaire, Amphion-Les-Bains, France). METHODS: We report a case series of 5 patients with PMD and unsatisfactory refractive correction managed at Clermont-Ferrand university hospital from January to December 2018 fitted with customized SPOT scleral lenses. We assessed the best-corrected visual acuity (BCVA) before and after fitting with SPOT, keratometric data and tolerability of the scleral lenses. RESULTS: Nine eyes of 5 patients aged 51.8±8.47 years were fitted. The BCVA was significantly improved from 0.51 logMAR (±0.39) to 0.04 logMAR (±0.07) (P<0.001). Sixty-six percent of the patients recovered optimal BCVA. No serious adverse event was reported. The presence of whitish deposits and an inordinate amount of manipulation required were the main disadvantages of the lenses. Nevertheless, all the patients considered them to be comfortable. CONCLUSION: Fitting PMD patients who have failed conventional optical devices with SPOT scleral lenses significantly improves BCVA, without serious adverse events, allowing surgery to be deferred even when it appears to be unavoidable.


Assuntos
Lentes de Contato , Doenças da Córnea/reabilitação , Doenças da Córnea/cirurgia , Ajuste de Prótese , Baixa Visão/reabilitação , Adulto , Idoso , Estudos de Coortes , Doenças da Córnea/diagnóstico , Topografia da Córnea , Feminino , Angiofluoresceinografia , Humanos , Masculino , Pessoa de Meia-Idade , Ajuste de Prótese/métodos , Esclera/diagnóstico por imagem , Esclera/patologia , Resultado do Tratamento , Baixa Visão/diagnóstico
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...