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1.
Int Ophthalmol ; 44(1): 405, 2024 Oct 11.
Artigo em Inglês | MEDLINE | ID: mdl-39392516

RESUMO

PURPOSE: The interplay between myopia and glaucoma has gained attention, with escalating myopia demonstrating a significant association with increased POAG rates, particularly in patients with severe myopia. This systematic review aimed to comprehensively analyze the relationship between myopia and glaucoma, focusing on the structural and functional implications, risk factors, and assessment modalities. Optical coherence tomography (OCT) played a crucial role in this study, particularly in highly myopic populations. METHODS: This study's rigor is underscored by using the PRISMA guidelines, which ensured a meticulous search strategy was employed across multiple databases from 2012 to 2024. The inclusion criteria included individuals aged 18 years or older with high myopia, defined as a spherical equivalent of less than -6.0 diopters or an axial length > 26.0 mm, diagnosed with chronic glaucoma. Various study designs were incorporated, including randomized controlled trials, prospective cohort studies, and observational studies. Quality assessment was performed using the Jadad Scale, and statistical analyses were performed to summarize the study characteristics and outcomes. RESULTS: Of the 350 initial articles, 15 met the inclusion criteria. OCT assessments revealed structural changes such as thinning of the retinal nerve fiber layer preceding functional losses. Meta-analyses demonstrated a heightened risk of POAG with increasing myopia severity, showing a significant nonlinear relationship. This meta-analysis of six studies involving 3040 patients revealed a relationship between myopia and glaucoma (OR = 12.0, 95% CI 10.1-4.7, P < 0.00001). CONCLUSION: This comprehensive analysis consolidates the evidence of the relationship between myopia and glaucoma, emphasizing the pivotal role of OCT and other imaging modalities in early detection and monitoring.


Glaucoma is a significant cause of permanent blindness worldwide. This causes damage to the visual nerve that worsens over time. The primary way to treat open-angle glaucoma and its many causes is to lower eye pressure. Further research is being conducted to determine the relationship between nearsightedness and glaucoma. Increased nearsightedness is significantly linked to higher rates of glaucoma, especially in people with severe nearsightedness. This review aimed to examine the link between myopia and glaucoma in greater depth, focusing on structural and functional effects, risk factors, and assessment methods, especially optical coherence tomography (OCT), in very nearsighted people. We conducted a thorough search of several databases between 2012 and 2024. Individuals aged 18 years or older with myopia greater than six diopters or an axial length greater than 26 mm and a diagnosis of chronic glaucoma were eligible. Randomized controlled trials, prospective cohort studies, and observational studies were some of the methods used in this study. The quality of the work and statistical methods were used to summarize the features and results of the study. Of the 350 articles initially published, only 15 met the inclusion criteria. These studies mostly used different optical tomography tests to detect structural changes, such as ocular nerve fiber layer damage, before functional loss. According to meta-analyses, the risk of chronic glaucoma increases as myopia worsens, indicating a solid nonlinear relationship. Myopia and glaucoma are linked, demonstrating the importance of thorough evaluation. Severe myopia is strongly associated with damage to the visual nerve. Over the past few years, optical tomography has become a vital imaging tool for identifying early damage to the optic nerve. However, further research is needed on the sex-related tendencies of glaucoma patients. This study provides data that reveal a link between nearsightedness and glaucoma, highlighting the importance of optical tomography and other imaging techniques for early detection and monitoring. To better manage glaucoma in highly myopic individuals, we need to understand how the severity of myopia, changes in structure, and changes in function affect each other.


Assuntos
Glaucoma , Miopia , Células Ganglionares da Retina , Tomografia de Coerência Óptica , Humanos , Glaucoma/fisiopatologia , Glaucoma/diagnóstico , Glaucoma/complicações , Pressão Intraocular/fisiologia , Miopia/diagnóstico , Miopia/fisiopatologia , Miopia/complicações , Fibras Nervosas/patologia , Disco Óptico/diagnóstico por imagem , Disco Óptico/patologia , Células Ganglionares da Retina/patologia , Fatores de Risco , Tomografia de Coerência Óptica/métodos , Campos Visuais/fisiologia
2.
Cir Cir ; 92(3): 324-330, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38862104

RESUMO

OBJECTIVE: The objective of the study is to compare the optic coherence tomography (OCT) parameters of the healthy and affected sides of patients with idiopathic sudden sensorineural hearing loss (ISSNHL) and to investigate the relationships between these and the improvement in hearing levels. METHODS: A bilateral eye evaluation of patients diagnosed with ISSNHL was performed with OCT. The ganglion cell complex (GCC) and retina nerve fiber layer (RNFL) thickness values were recorded and the differences between the two eyes were examined. RESULTS: An evaluation was made of 39 patients with a mean age of 44.82 ± 14.90 years. The RNFL thickness of the eyes was determined to be mean 89.87 ± 3.65 µm on the affected side and 103.87 ± 3.98 µm on the healthy control side (p = 0.0001). The mean GCC was determined to be mean 90.46 ± 3.49 µm on the affected side and 103.77 ± 3.96 µm on the healthy control side (p = 0.0001). CONCLUSIONS: A statistically significant difference was observed between the healthy and affected eyes of patients with ISSNHL with respect to mean GCC and mean RNFL thickness. OCT could be a useful technique for measuring this neural degeneration.


OBJETIVO: Comparar e investigar los parámetros de la tomografía de coherencia óptica (OCT) de los lados sanos y afectados de pacientes con pérdida auditiva neurosensorial súbita idiopática (PANSI). MÉTODO: La evaluación ocular bilateral de los pacientes diagnosticados con PANSI se realizó con OCT. Se registraron los valores de espesor del complejo de células ganglionares (CCG) y de la capa de fibras nerviosas de la retina (CFNR), y se examinaron las diferencias entre los dos ojos. RESULTADOS: Se evaluaron 39 pacientes, con una edad media de 44.82 ± 14.90 años. Se determinó que el grosor de la CFNR de los ojos era una media de 89.87 ± 3.65 µm en el lado afectado y 103.87 ± 3.98 µm en el lado de control sano (p = 0.0001). Se determinó que el CCG medio era 90.46 ± 3.49 µm en el lado afectado y 103.77 ± 3.96 µm en el lado de control sano (p = 0.0001). CONCLUSIONES: Se encontró una diferencia estadísticamente significativa entre los ojos sanos y afectados de pacientes con PANSI con respecto al CCG medio y al espesor medio de la CFNR. La OCT podría ser una técnica útil para medir esta degeneración neuronal.


Assuntos
Axônios , Fibras Nervosas , Tomografia de Coerência Óptica , Humanos , Tomografia de Coerência Óptica/métodos , Adulto , Feminino , Masculino , Fibras Nervosas/patologia , Pessoa de Meia-Idade , Axônios/patologia , Células Ganglionares da Retina/patologia , Perda Auditiva Neurossensorial/diagnóstico por imagem , Perda Auditiva Súbita/diagnóstico por imagem , Adulto Jovem
3.
J Peripher Nerv Syst ; 29(2): 221-231, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38706223

RESUMO

BACKGROUND: ATTR (ATTRv) amyloidosis neuropathy is characterized by progressive sensorimotor and autonomic nerve degeneration secondary to amyloid deposition caused by a misfolded transthyretin protein (TTR). Small nerve fiber neuropathy is an early clinical manifestation of this disease resulting from the dysfunction of the Aδ and C small nerve fibers. Tafamidis, a selective TTR stabilizer, has proven its efficacy in the earlier stages of hATTR. OBJECTIVES: To evaluate the clinical course and utility of cutaneous pathological biomarkers in patients with ATTR amyloidosis treated with tafamidis compared to control patients. METHODS: Forty patients diagnosed with early stages of ATTRv amyloidosis (polyneuropathy disability [PND] scores 0-II) underwent small and large nerve fiber neurological evaluations, and annual skin biopsies for intraepidermal nerve fiber density (IENFD) and amyloid deposition index (ADI) estimation. Thirty patients were allocated to receive tafamidis, and 10 patients served as controls. Tafamidis pharmacokinetics analysis was performed in patients who received the treatment. RESULTS: At baseline, 12% of patients in stage PND 0 and 28% in PND I displayed small nerve fiber denervation in the distal thigh, whereas 23% and 38%, respectively, in the distal leg. Similarly, 72% and 84% had amyloid deposition in the distal thigh and 56% and 69% in the distal leg. Following 1 year of treatment, the tafamidis group showed significant clinical improvement compared to the control group, revealed by the following mean differences (1) -9.3 versus -4 points (p = <.00) in the patient's neuropathy total symptom score 6 (NTSS-6) questionnaire, (2) -2.5 versus +2.8 points (p = <.00) in the Utah Early Neuropathy Score (UENS), and (3) +1.2°C versus -0.6 (p = .01) in cold detection thresholds. Among the patients who received tafamidis, 65% had stable or increased IENFD in their distal thigh and 27% in the distal leg. In contrast, all patients in the control group underwent denervation. The ADI either decreased or remained constant in 31% of the biopsies in the distal thigh and in 24% of the biopsies in the distal leg of the tafamidis-treated patients, whereas it rose across all the biopsies in the control group. At the 4-year follow-up, the tafamidis group continued to display less denervation in the distal thigh (mean difference [MD] of -3.0 vs. -9.3 fibers/mm) and the distal leg (mean difference [MD] -4.9 vs. -8.6 fibers/mm). ADI in tafamidis-treated patients was also lower in the distal thigh (10 vs. 30 amyloid/mm2) and the distal leg (23 vs. 40 amyloid/mm2) compared to control patients. Plasma tafamidis concentrations were higher in patients with IENFD improvement and in patients with reduced amyloid deposition. Patients without amyloid deposition in the distal leg at baseline displayed delayed disease progression at 4 years. CONCLUSIONS: Cutaneous IENFD and amyloid deposition assessments in the skin of the distal thigh and distal leg are valuable biomarkers for early diagnosis of ATTR amyloidosis and for measuring the progression of small nerve fiber neuropathy. Early treatment with tafamidis slows the clinical progression of the disease, skin denervation, and amyloid deposition in the skin. Higher plasma concentrations of tafamidis are associated with better disease outcomes, suggesting that increasing the drug dose could achieve better plasma concentrations and response rates. This study describes the longest small nerve fiber neuropathy therapeutic trial with tafamidis and is the first to report small fiber symptoms, function, and structural assessments as outcomes.


Assuntos
Neuropatias Amiloides Familiares , Benzoxazóis , Pele , Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Neuropatias Amiloides Familiares/tratamento farmacológico , Benzoxazóis/farmacologia , Benzoxazóis/administração & dosagem , Idoso , Pele/patologia , Pele/inervação , Pele/efeitos dos fármacos , Biomarcadores/metabolismo , Pré-Albumina , Adulto , Resultado do Tratamento , Fibras Nervosas/efeitos dos fármacos , Fibras Nervosas/patologia
4.
Arq Bras Oftalmol ; 87(4): e2023, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38656023

RESUMO

PURPOSE: We aimed to evaluate retinal nerve fiber and choroidal layer alterations in adolescents with anorexia nervosa using spectral-domain optical coherence tomography. METHODS: Thirty patients with anorexia nervosa and 30 healthy adolescents aged 12-18 years were included in this study. Their age, sex, body mass index, anorexia nervosa type, disease duration, and spectral-domain optical coherence tomography data were recorded. RESULTS: Central macular thickness and retinal nerve fiber layer thickness in the temporal and inferior regions were significantly lesser in patients with anorexia than in healthy controls (p<0.05). Moreover, significant choroidal thinning around the foveal and subfoveal regions in patients with anorexia was observed (p<0.05). In addition, a statistically significant relation between the increase in disease duration and the thinning of the inferior retinal nerve fiber layer was detected (p<0.05). CONCLUSION: The retinal nerve fiber layer and choroidal layer thicknesses were lesser in patients with anorexia than in healthy controls. Screening for retinal indices might prevent the development of irreversible retinal pathologies in adolescents with anorexia nervosa. In addition, thinning of the retinal nerve fiber and choroidal layers could reflect structural or functional changes in the brain of adolescents with anorexia nervosa.


Assuntos
Anorexia Nervosa , Corioide , Fibras Nervosas , Tomografia de Coerência Óptica , Humanos , Anorexia Nervosa/diagnóstico por imagem , Anorexia Nervosa/patologia , Adolescente , Tomografia de Coerência Óptica/métodos , Feminino , Corioide/diagnóstico por imagem , Corioide/patologia , Fibras Nervosas/patologia , Estudos de Casos e Controles , Masculino , Criança , Retina/diagnóstico por imagem , Retina/patologia , Índice de Massa Corporal , Valores de Referência , Estatísticas não Paramétricas
5.
Arq Bras Oftalmol ; 86(5): e20210420, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37878951

RESUMO

PURPOSE: The purpose of this study was to assess the optic nerve head microvascular changes in pseudoexfoliative and primary open-angle glaucoma and define the relationship between vessel density and retinal nerve fiber layer thickness. METHODS: This observational cross-sectional study assessed 72 eyes with primary open-angle glaucoma, 41 eyes with pseudoexfoliative glaucoma, and 60 healthy eyes. On the basis of optic nerve head-centered, 4.5 mm × 4.5 mm scan size images, we evaluated the vessel density, as well as the peripapillary sector, inside disk, and all sectoral quadrants. RESULTS: Both glaucoma Groups had lower vessel density in all regions compared with the healthy Group (p<0.05 for all variables). Vessel densities of the nasal inferior, inferior nasal, and inferior temporal sectors in both glaucoma Groups showed similar results (p=0.157, p=0.128, p=0.143, respectively). Eyes with pseudoexfoliative glaucoma had significantly lower vessel densities than eyes with primary open-angle glaucoma in all other regions (p<0.05 for all variables). For both glaucoma Groups, the average retinal nerve fiber layer thickness positively correlated with vessel density in all peripapillary sectors (p<0.05 for all variables). CONCLUSIONS: Reduction in vessel density correlated with the thinning of retinal nerve fiber layer in both glaucoma Groups. Decreased vessel density in the optic nerve head can be used to demonstrate the microvascular pathologies and possible ischemic changes that lead to faster progression and worse prognosis in pseudoexfoliative glaucoma.


Assuntos
Glaucoma de Ângulo Aberto , Glaucoma , Disco Óptico , Humanos , Disco Óptico/diagnóstico por imagem , Disco Óptico/patologia , Glaucoma de Ângulo Aberto/diagnóstico por imagem , Glaucoma de Ângulo Aberto/patologia , Campos Visuais , Tomografia de Coerência Óptica/métodos , Células Ganglionares da Retina/patologia , Fibras Nervosas/patologia , Glaucoma/patologia , Vasos Retinianos/diagnóstico por imagem , Vasos Retinianos/patologia , Pressão Intraocular
6.
Einstein (Sao Paulo) ; 20: eMD8044, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35830153

RESUMO

Skin biopsy with investigation of small-diameter nerve fibers in human epidermis and dermis has been proven to be a useful method for confirming small-fiber neuropathy. In medical practice, small-fiber neuropathy is increasingly recognized as a leading cause of neuropathic pain. It is a prevalent complaint in medical offices, brought by patients often as a "painful burning sensation". The prevalence of neuropathic pain is high in small-fiber neuropathies of different etiologies, especially in the elderly; 7% of population in this age group present peripheral neuropathy. Pain and paresthesia are symptoms which might cause disability and impair quality of life of patients. The early detection of small-fiber neuropathy can contribute to reducing unhealthy lifestyles, associated to higher incidence of the disease.


Assuntos
Fibras Nervosas , Neuralgia , Pele , Idoso , Biópsia/efeitos adversos , Humanos , Fibras Nervosas/patologia , Neuralgia/diagnóstico , Neuralgia/etiologia , Neuralgia/patologia , Qualidade de Vida , Pele/patologia
7.
Arq Bras Oftalmol ; 85(3): 286-293, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35730818

RESUMO

PURPOSE: To evaluate the radial peripapillary capillary density using optical coherence tomography angiography in patients with and without Helicobacter pylori infection. METHODS: This prospective, cross-sectional study comprised 52 patients (52 eyes: Group 1) and 38 patients (38 eyes: Group 2) with and without H. pylori infections, respectively. The radial peripapillary capillary density and retinal nerve fiber layer thickness in 4 equal quadrants and 2 equal hemispheres in the peripapillary region were calculated using optical coherence tomography angiography. The optic nerve head parameters of the patients were also assessed. RESULTS: The groups were similar in terms of age, gender, and the optic nerve head parameters. The radial peripapillary capillary densities in the superior hemisphere and quadrant were significantly lower in Group 1 than in Group 2 (p=0.039 and p=0.028, respectively) and were positively correlated with the superior hemisphere's retinal nerve fiber layer thickness (p<0.001 and p<0.001, respectively). Similarly, the radial peripapillary capillary densities in the inferior hemisphere and quadrant were also significantly lower in Group 1 compared to Group 2 (p=0.03 and p=0.017, respectively) and were positively correlated with the inferior hemisphere's retinal nerve fiber layer thickness (p<0.001 and p<0.001, respectively). The retinal nerve fiber layer thickness in the nasal and temporal quadrants were significantly decreased in Group 1 when compared to Group 2 (p=0.013 and p=0.022) and were positively correlated with the corresponding radial peripapillary capillary densities of the 2 quadrants (p=0.002 and p=0.022). CONCLUSION: The decreased radial peripapillary capillary density in the H. pylori-positive patients suggests that H. pylori may play a role in the etiopathogenesis of glaucoma.


Assuntos
Infecções por Helicobacter , Helicobacter pylori , Estudos Transversais , Angiofluoresceinografia/métodos , Infecções por Helicobacter/complicações , Infecções por Helicobacter/patologia , Humanos , Fibras Nervosas/patologia , Estudos Prospectivos , Vasos Retinianos/diagnóstico por imagem , Vasos Retinianos/patologia , Tomografia de Coerência Óptica/métodos
8.
Int Ophthalmol ; 42(5): 1369-1380, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-34822051

RESUMO

PURPOSE: Vasospasm represents an early event in systemic sclerosis (SSc). Ocular vasospasm may induce optic nerve head (ONH) damage and has been involved in the pathogenesis of glaucoma, especially normal-tension glaucoma (NTG). We aimed to investigate the presence of structural abnormalities associated with NTG using swept-source optical coherence tomography (SS-OCT) and to correlate the OCT parameters with clinical, capillaroscopy and digital blood flow measures in patients with SSc. METHODS: In this cross-sectional study, 40 patients with SSc and 23 age-matched controls were included. The following parameters were measured using SS-OCT: mean and sectoral retinal nerve fibre layer (RNFL) thickness, macular ganglion cell layer complex (GCC) thickness and ONH morphology. Nailfold capillaroscopy (NFC) and digital blood flow measurements using laser Doppler imaging (LDI) were performed in all subjects. RESULTS: Patients with SSc showed a thinner temporal RNFL than the controls (69.23 ± 11.74 versus 83.35 ± 20.19 µm, p = 0.001). The other parameters were similar between the two groups. In SSc patients, there was an inverse correlation between the disease duration and the average, superior and inferior RNFL thickness and the GCC thickness and between Raynaud's phenomenon duration and the average RNFL and GCC thickness (p < 0.05). NFC and LDI measurements did not show correlations with OCT parameters. CONCLUSION: A thinner temporal RNFL and the correlation between Raynaud's phenomenon and disease duration and structural abnormalities on OCT suggest the presence of early ganglion cell damage in patients with SSc. Although mild, these findings indicate the need to monitor ocular abnormalities in SSc.


Assuntos
Glaucoma , Glaucoma de Baixa Tensão , Escleroderma Sistêmico , Estudos Transversais , Glaucoma/diagnóstico , Glaucoma/etiologia , Glaucoma/patologia , Humanos , Pressão Intraocular , Glaucoma de Baixa Tensão/diagnóstico , Fibras Nervosas/patologia , Células Ganglionares da Retina/patologia , Escleroderma Sistêmico/complicações , Escleroderma Sistêmico/diagnóstico , Tomografia de Coerência Óptica/métodos , Campos Visuais
9.
Ophthalmology ; 129(2): 161-170, 2022 02.
Artigo em Inglês | MEDLINE | ID: mdl-34474070

RESUMO

PURPOSE: To investigate the effect of systemic arterial blood pressure (BP) on rates of progressive structural damage over time in glaucoma. DESIGN: Retrospective cohort study. PARTICIPANTS: A total of 7501 eyes of 3976 subjects with glaucoma or suspected of glaucoma followed over time from the Duke Glaucoma Registry. METHODS: Linear mixed models were used to investigate the effects of BP on the rates of retinal nerve fiber layer (RNFL) loss from spectral-domain OCT (SD-OCT) over time. Models were adjusted for intraocular pressure (IOP), gender, race, diagnosis, central corneal thickness (CCT), follow-up time, and baseline disease severity. MAIN OUTCOME MEASURE: Effect of mean arterial pressure (MAP), systolic arterial pressure (SAP), and diastolic arterial pressure (DAP) on rates of RNFL loss over time. RESULTS: A total of 157 291 BP visits, 45 408 IOP visits, and 30 238 SD-OCT visits were included. Mean rate of RNFL change was -0.70 µm/year (95% confidence interval, -0.72 to -0.67 µm/year). In univariable models, MAP, SAP, and DAP during follow-up were not significantly associated with rates of RNFL loss. However, when adjusted for mean IOP during follow-up, each 10 mmHg reduction in mean MAP (-0.06 µm/year; P = 0.007) and mean DAP (-0.08 µm/year; P < 0.001) but not SAP (-0.01 µm/year; P = 0.355) was associated with significantly faster rates of RNFL thickness change over time. The effect of the arterial pressure metrics remained significant after additional adjustment for baseline age, diagnosis, sex, race, follow-up time, disease severity, and corneal thickness. CONCLUSIONS: When adjusted for IOP, lower MAP and DAP during follow-up were significantly associated with faster rates of RNFL loss, suggesting that levels of systemic BP may be a significant factor in glaucoma progression.


Assuntos
Pressão Sanguínea/fisiologia , Glaucoma/diagnóstico , Glaucoma/fisiopatologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Pressão Arterial/fisiologia , Progressão da Doença , Feminino , Seguimentos , Humanos , Pressão Intraocular/fisiologia , Masculino , Pessoa de Meia-Idade , Fibras Nervosas/patologia , Hipertensão Ocular/fisiopatologia , Sistema de Registros , Células Ganglionares da Retina/patologia , Estudos Retrospectivos , Tomografia de Coerência Óptica , Tonometria Ocular
10.
Am J Ophthalmol ; 234: 156-165, 2022 02.
Artigo em Inglês | MEDLINE | ID: mdl-34453885

RESUMO

PURPOSE: To compare optical coherence tomography-measured Bruch membrane opening minimum rim width (MRW), peripapillary retinal nerve fiber layer (pRNFL) measurements, and MRW:pRNFL ratios in eyes with compressive optic neuropathy (CON) and glaucoma and controls, and evaluate the ability of these parameters to differentiate CON from glaucoma. DESIGN: Prospective, cross-sectional study. METHODS: Setting: Single-center tertiary hospital and outpatient clinic. PATIENT POPULATION: One hundred fifteen eyes of 77 participants, 34 with CON from chiasmal lesions, 21 with glaucoma, and 22 healthy controls. OBSERVATION PROCEDURES: Optical coherence tomography-measured MRW, pRNFL, and MRW:pRNFL ratios for each optic disc sector and global average. MAIN OUTCOME MEASURES: MRW, pRNFL, and MRW:pRNFL ratios compared using generalized estimated equations. Area under the receiver operating characteristic curve and positive and negative likelihood ratios were calculated. RESULTS: MRW and pRNFL measurements were significantly reduced in CON and glaucoma compared with controls. In glaucoma, MRW was thinner than in CON in the global, inferotemporal, superonasal, inferonasal, and vertical average measurements, but a significant overlap was observed in many parameters. MRW:pRNFL ratios increased the ability to discriminate between CON and glaucoma, as shown by the high area under the receiver operating characteristic curve, high positive likelihood ratios, and low negative likelihood ratios, especially in the nasal disc sector and the nasal and temporal average. CONCLUSIONS: MRW measurements alone cannot reliably distinguish CON from glaucoma, but the combination of MRW, pRNFL, and MRW:pRNFL ratios significantly improves accuracy. When comparing the 2 conditions, MRW:pRNFL ratios yielded higher area under the receiver operating characteristic curve and positive and negative likelihood ratios, suggesting this parameter may be helpful in clinical practice.


Assuntos
Glaucoma , Doenças do Nervo Óptico , Lâmina Basilar da Corioide/patologia , Estudos Transversais , Glaucoma/diagnóstico , Glaucoma/patologia , Humanos , Pressão Intraocular , Fibras Nervosas/patologia , Doenças do Nervo Óptico/diagnóstico , Doenças do Nervo Óptico/patologia , Estudos Prospectivos , Tomografia de Coerência Óptica , Campos Visuais
11.
Rev. bras. oftalmol ; 81: e0103, 2022. graf
Artigo em Inglês | LILACS | ID: biblio-1407672

RESUMO

ABSTRACT Optical coherence tomography is often used for detection of glaucoma as well as to monitor progression. This paper reviews the most common types of artifacts on the optical coherence tomography report that may be confused with glaucomatous damage. We mainly focus on anatomy-related artifacts in which the retinal layer segmentation and thickness measurements are correct. In such cases, the probability maps (also known as deviation maps) show abnormal (red and yellow) regions, which may mislead the clinician to assume disease is present. This is due to the anatomic variability of the individual, and the normative database must be taken into account.


RESUMO A tomografia de coerência óptica é frequentemente usada para detectar glaucoma, bem como para monitorar a progressão. Este artigo analisa os tipos mais comuns de artefatos no relatório de tomografia de coerência óptica que podem ser confundidos com danos glaucomatosos. Nós nos concentramos principalmente nos artefatos relacionados à anatomia em que a segmentação da camada da retina e as medidas de espessura estão corretas. Nesses casos, os mapas de probabilidade (também conhecidos como mapas de desvio) mostram regiões anormais (vermelho e amarelo), o que pode induzir o clínico em erro ao supor que a doença está presente. Isto se deve à variabilidade anatômica do indivíduo, e o banco de dados normativo deve ser levado em conta.


Assuntos
Humanos , Glaucoma/diagnóstico por imagem , Artefatos , Tomografia de Coerência Óptica/métodos , Postura , Retina/diagnóstico por imagem , Anormalidade Torcional , Movimentos da Cabeça , Erros de Diagnóstico , Movimentos Oculares , Fóvea Central , Fibras Nervosas/patologia
12.
Rev. bras. oftalmol ; 81: e0069, 2022. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1407675

RESUMO

ABSTRACT Objective: To evaluate structural and visual field (VF) changes after ≥1 year of a single acute primary angle closure (APAC) attack using spectral-domain optical coherence tomography (SD-OCT) and standard automated perimetry (SAP). Methods: Patients with a single unilateral APAC crisis at least 1 year ago were included consecutively from 2013 to 2016. Contralateral eye was used as control. All patients underwent ophthalmic examination, RNFL imaging by SD-OCT, and SAP using Octopus 1-2-3. Results: 54 eyes (27 patients) were enrolled. Male-to-female ratio was 1:2. Mean time for the SD-OCT and SAP assessment after the crisis was 5.0±5.1 (1.0-23.5) years, and IOP was 52.5±9.8 mmHg. In APAC eyes, the thicknesses of all quadrants of peripapillary RNFL (36.3%; P<0.001) and some macular sections (from 2.1% to 4.7%; P<0.01) were reduced compared to contralateral eyes. Additionally, in APAC eyes, the mean defect on VF was negatively and statistically correlated with the reduction of all quadrants of peripapillary RNFL thickness. Conclusion: A single episode of APAC was associated with peripapillary RNFL and macular thickness and with VF defects after ≥1 year of the crisis in the affected eye. Statistically meaningful correlations were found between structural and functional damage.


RESUMO Objetivo: Avaliar alterações estruturais e do campo visual 1 ano ou mais após uma crise única de fechamento angular primário agudo utilizando tomografia de coerência óptica de domínio espectral e perimetria automatizada padronizada. Métodos: Pacientes que apresentaram crise unilateral única de fechamento angular primário agudo há pelo menos 1 ano foram consecutivamente incluídos entre 2013 e 2016. Os olhos contralaterais foram utilizados como controles. Todos os pacientes foram submetidos a exame oftalmológico, avaliação das camadas de fibras nervosas da retina utilizando tomografia de coerência óptica de domínio espectral e perimetria automatizada padronizada com o Octopus 1-2-3. Resultados: Foram incluídos 54 olhos (27 pacientes) com razão homem:mulher de 1:2. O tempo médio após a crise foi de 5,0±5,1 anos (1,0 a 23,5) e a pressão intraocular na crise foi 52,5±9,8mmHg. Nos olhos com fechamento angular primário agudo, todas as espessuras das camadas de fibras nervosas da retina peripapilares (36,3%; p<0,001) e de algumas seções maculares (de 2,1 a 4,7%; p<0,01) estavam reduzidas em comparação aos olhos contralaterais. Além do mais, nos olhos submetidos a fechamento angular primário agudo, o mean defect do campo visual foi estatisticamente e negativamente correlacionado com a redução da espessura de todos os quadrantes peripapilares da camada de fibras nervosas da retina. Conclusão: Um único episódio de fechamento angular primário agudo foi associado com redução na espessura da camada de fibras nervosas da retina peripapilar e da espessura macular e com defeitos de campo visual 1 ano ou mais após a crise no olho afetado. Correlações estatisticamente significativas foram identificadas entre danos estruturais e funcionais.


Assuntos
Humanos , Masculino , Feminino , Disco Óptico/patologia , Glaucoma de Ângulo Fechado/diagnóstico por imagem , Doenças do Nervo Óptico/diagnóstico por imagem , Tomografia de Coerência Óptica/métodos , Fibras Nervosas/patologia , Campos Visuais , Glaucoma de Ângulo Fechado/complicações , Doenças do Nervo Óptico/etiologia , Doença Aguda , Iridectomia , Testes de Campo Visual , Pressão Intraocular , Macula Lutea
13.
Rev. bras. oftalmol ; 81: e0038, 2022. graf
Artigo em Inglês | LILACS | ID: biblio-1376777

RESUMO

ABSTRACT Myelinated retinal nerve fibers are rare congenital anomalies that appear as gray-white patches. They may be present in a syndrome characterized by ipsilateral myelinated retinal nerve fibers, myopia and amblyopia. The author reported an ellipsoid zone defect on spectral domain optical coherence tomography in a case of Straatsma syndrome without macular extension.


RESUMO Fibras nervosas retinais mielinizadas são anomalias congênitas raras que aparecem como manchas branco-acinzentadas. Eles podem se apresentar em uma síndrome caracterizada por fibras nervosas retinais mielinizadas ipsilaterais, miopia e ambliopia. O autor relatou um defeito na zona elipsoide na tomografia de coerência óptica de domínio espectral em um caso de síndrome de Straatsma sem extensão macular.


Assuntos
Humanos , Feminino , Adolescente , Doenças Retinianas/patologia , Doenças Retinianas/diagnóstico por imagem , Fibras Nervosas/patologia , Fibras Nervosas Mielinizadas/patologia , Disco Óptico , Ambliopia , Anormalidades do Olho/diagnóstico por imagem , Tomografia de Coerência Óptica , Fundo de Olho , Bainha de Mielina , Miopia
14.
Rev. bras. oftalmol ; 80(2): 96-99, Mar.-Apr. 2021. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1280112

RESUMO

ABSTRACT Purpose: to compare the Subfoveal choroidal thickness (SFCT) and Retinal Nerve Fiber Layer Thickness (RNFL) of amblyopic and normal fellow eyes. Design: Prospective, cross-sectional, observational case series. Methods: Forty patients age 12 to 41 years (mean 23.73 ± 6.42) with unilateral amblyopia were studied. Among them, 11(28.2%) patients had amblyopia secondary to strabismus and 29(71.8 %) had anisometropic amblyopia. Optical coherence tomography (OCT) of the peripapillary RNFL thickness of amblyopic and fellow eyes was performed. RNFL thickness measurements were taken from the superior, inferior, nasal and temporal quadrants in the peripapillary region. Also, subfoveal choroidal thickness (SFCT) was measured using spectral domain optical coherence tomography (SD-OCT). Results: Mean global RNFL thickness of the amblyopic and fellow eyes was 104.48 microns and 102.83 microns, respectively. The difference between the two groups was not statistically significant (p>0.05%). The thicknesses of the superior, inferior, nasal and temporal quadrants of the retinal nerve fiber layer between the amblyopic and normal fellow eyes showed no statistically significant difference (p>0.05%). However, the SFCT of amblyopic eye was 11 or more microns thicker than the fellow eye and this was statistically significant different (p<0.05%). Conclusions: This study demonstrated SFCT in amblyopic eyes was significantly thicker than the normal fellow eyes. The amblyopic process may involve the choroid, but not the prepapillary NFL.


RESUMO Objetivo: comparar a espessura da coroide subfoveal (CSF) e da camada de fibra nervosa retinal (CFNR) de olhos amblíopes e normais. Design: série de casos prospectivos, transversais e observacionais. Métodos: Quarenta pacientes com idade entre 12 e 41 anos (média 23,73 ± 6,42) com ambliopia unilateral foram estudados. Entre eles, 11 (28,2%) pacientes apresentavam ambliopia secundária a estrabismo e 29 (71,8%) apresentavam ambliopia anisometrópica. Foi realizada tomografia de coerência óptica (TCO) da espessura da CFNR peripapilar do olho amblíope e do outro olho. As medidas de espessura da CFNR foram realizadas nos quadrantes superior, inferior, nasal e temporal na região peripapilar. Além disso, a espessura da coroide subfoveal (CSF) foi medida através de tomografia de coerência óptica de domínio espectral (TCO-DE). Resultados: A espessura média global da CFNR do olho amblíope e do outro olho foi de 104,48 mícrons e 102,83 mícrons, respectivamente. A diferença entre os dois grupos não foi estatisticamente significativa (p > 0,05%). As espessuras dos quadrantes superior, inferior, nasal e temporal da camada de fibras nervosas da retina entre o olho amblíope e o normal não apresentaram diferença estatisticamente significativa (p > 0,05%). No entanto, a CSF do olho amblíope foi 11 mícrons mais espessa (ou mais) do que a do outro olho - essa diferença foi estatisticamente significativa (p < 0,05%). Conclusões: Este estudo demonstrou que a CSF dos olhos amblíopes foi significativamente mais espessa do que a dos olhos normais. O processo amblíope pode envolver a coroide, mas ele não envolve a CFNR peripapilar.


Assuntos
Humanos , Masculino , Feminino , Criança , Adolescente , Adulto , Ambliopia/complicações , Ambliopia/diagnóstico por imagem , Corioide/diagnóstico por imagem , Fibras Nervosas/patologia , Disco Óptico/patologia , Nervo Óptico/patologia , Tamanho do Órgão , Células Ganglionares da Retina/patologia , Acuidade Visual , Estudos Transversais , Estudos Prospectivos , Corioide/patologia , Tomografia de Coerência Óptica/métodos , Fóvea Central/patologia
16.
Exp Neurol ; 332: 113390, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32598929

RESUMO

Because environmental elements modify chronic pain development and endogenous mechanisms of pain control are still a great therapeutic source, we investigated the effects of an early exposure to environmental enrichment (EE) in a translational model of neuropathic pain. Young male rats born and bred in an enriched environment, which did not count on running wheel, underwent chronic constriction injury (CCI) of sciatic nerve. EE abolished neuropathic pain behavior 14 days after CCI. Opioid receptors' antagonism reversed EE-analgesic effect. ß-endorphin and met-enkephalin serum levels were increased only in EE-CCI group. Blockade of glucocorticoid receptors did not alter EE-analgesic effect, although corticosterone circulating levels were increased in EE animals. In the spinal cord, EE controlled CCI-induced serotonin increase. In DRG, EE blunted the expression of ATF-3 after CCI. Surprisingly, EE-CCI group showed a remarkable preservation of sciatic nerve fibers compared to NE-CCI group. This work demonstrated global effects induced by an EE protocol that explain, in part, the protective role of EE upon chronic noxious stimulation, reinforcing the importance of endogenous mechanisms in the prevention of chronic pain development.


Assuntos
Meio Ambiente , Neuralgia/prevenção & controle , Traumatismos dos Nervos Periféricos/complicações , Nervo Isquiático/lesões , Animais , Sobrevivência Celular , Constrição Patológica , Endorfinas/sangue , Encefalinas/sangue , Hiperalgesia/patologia , Masculino , Fibras Nervosas/patologia , Neuralgia/etiologia , Neuralgia/patologia , Traumatismos dos Nervos Periféricos/patologia , Ratos , Ratos Wistar , Receptores de Glucocorticoides/metabolismo , Nervo Isquiático/patologia , Medula Espinal/metabolismo , Suporte de Carga
17.
Braz. J. Psychiatry (São Paulo, 1999, Impr.) ; Braz. J. Psychiatry (São Paulo, 1999, Impr.);42(3): 309-313, May-June 2020. tab
Artigo em Inglês | LILACS | ID: biblio-1132084

RESUMO

Objective: To compare intraocular pressure (IOP) and macular, retinal nerve fiber layer (RNFL), and ganglion cell layer (GCL) thicknesses in treatment-naive children with attention-deficit/hyperactivity disorder (ADHD), children with ADHD on regular methylphenidate (MPH) treatment for at least 3 months, and healthy controls. Methods: A total of 58 treatment-naive children with ADHD, 45 children with ADHD on regular MPH treatment, and 44 healthy controls were enrolled in this study. All participants underwent a comprehensive eye examination. Optical coherence tomography (OCT) was used to assess global RNFL thickness, central macular thickness, and GCL thickness in both eyes. Results: Separate univariate analysis of covariance (ANCOVA) on the outcome variables revealed a significant difference among the research groups with respect to IOP in the left eye. Post-hoc univariate analyses indicated that left IOP was significantly higher in children with ADHD under MPH treatment than among healthy controls. However, global RNFL thickness, central macular thickness, and GCL thickness of both eyes, as well as IOP in the right eye, were not significantly different across groups. Conclusion: Further longitudinal follow-up studies are needed to determine whether MPH treatment has any effect on IOP or OCT findings.


Assuntos
Humanos , Masculino , Feminino , Criança , Adolescente , Células Ganglionares da Retina/patologia , Transtorno do Deficit de Atenção com Hiperatividade/fisiopatologia , Transtorno do Deficit de Atenção com Hiperatividade/patologia , Pressão Intraocular/fisiologia , Macula Lutea/patologia , Fibras Nervosas/patologia , Valores de Referência , Retina/patologia , Estudos de Casos e Controles , Análise de Variância , Tomografia de Coerência Óptica
18.
Front Immunol ; 11: 368, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32265900

RESUMO

Introduction: Leprosy is an infectious disease caused by Mycobacterium leprae, a debilitating disease that affects the skin and peripheral nerves. It is possible that tissue changes during infection with leprosy are related to alterations in the activity of the Notch signaling pathway, an innate signaling pathway in the physiology of the skin and peripheral nerves. Methods: This is a descriptive observational study. Thirty skin biopsies from leprosy patients and 15 from individuals with no history of this disease were evaluated. In these samples, gene expressions of cellular components associated with the Notch signaling pathway, Hes-1, Hey-1, Runx-1 Jagged-1, Notch-1, and Numb, were evaluated using q-PCR, and protein expression was evaluated using immunohistochemistry of Runx-1 and Hes-1. Results: Changes were observed in the transcription of Notch signaling pathway components; Hes-1 was downregulated and Runx-1 upregulated in the skin of infected patients. These results were confirmed by immunohistochemistry, where reduction of Hes-1 expression was found in the epidermis, eccrine glands, and hair follicles. Increased expression of Runx-1 was found in inflammatory cells in the dermis of infected patients; however, it is not related to tissue changes. With these results, a multivariate analysis was performed to determine the causes of transcription factor Hes-1 reduction. It was concluded that tissue inflammation was the main cause. Conclusions: The tissue changes found in the skin of infected patients could be associated with a reduction in the expression of Hes-1, a situation that would promote the survival and proliferation of M. leprae in this tissue.


Assuntos
Hanseníase/metabolismo , Fibras Nervosas/patologia , Receptores Notch/fisiologia , Pele/metabolismo , Adulto , Idoso , Subunidade alfa 2 de Fator de Ligação ao Core/análise , Ciclina D1/análise , Feminino , Humanos , Imuno-Histoquímica , Hanseníase/patologia , Masculino , Pessoa de Meia-Idade , Fibras Nervosas/química , Transdução de Sinais/fisiologia , Pele/patologia , Fatores de Transcrição HES-1/análise
19.
Arq. bras. oftalmol ; Arq. bras. oftalmol;83(2): 132-140, Mar.-Apr. 2020. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1088966

RESUMO

ABSTRACT Purpose: To investigate the relationships between (i) thickness of the retinal nerve fiber layer, optic nerve head topography, and visual field parameters and (ii) corneal biomechanical properties in normal controls and patients with ocular hypertension and primary open-angle glaucoma. Methods: This observational, cross-sectional study included 68 eyes with primary open-angle glaucoma, 99 eyes with ocular hypertension and 133 control eyes. Corneal biomechanical properties, optic nerve head topographic features, retinal nerve fiber layer thickness, and visual fields were assessed in all cases. Corneal biomechanical properties, retinal nerve fiber layer thicknesses, and optic nerve head topographic features were compared among the groups. The associations between structural and functional measures of glaucomatous damage and corneal biomechanical factors were also evaluated. Results: Significantly lower corneal hysteresis and corneal resistance factor values were observed in the primary open-angle glaucoma and ocular hypertension groups as compared with the control group, but there were no significant differences between the primary open-angle glaucoma and ocular hypertension groups. In the ocular hypertension group, no associations were observed between the corneal hysteresis and corneal resistance factor with values and the structural and functional parameters. In the primary open-angle glaucoma group, positive correlations were observed between the corneal hysteresis values and the global retinal nerve fiber layer thickness (p<0.01, r=0.27), mean retinal nerve fiber layer thickness (p<0.01, r=0.33), and mean deviation (p<0.01, r=0.26), and negative correlations were observed between the corneal resistance factor values, and the cup area (p<0.01, r=-0.39), cup-to-disk ratio (p=0.02, r=-0.28), linear cup-to-disk ratio (p=0.02, r=-0.28), and cup shape (p=0.03, r=-0.26). In the control group, weak correlations were detected between the corneal hysteresis and the cup area (p=0.03, r=0.19), cup-to-disk ratio (p=0.01, r=0.21), and linear cup-to-disk ratio (p=0.01, r=0.22). Conclusions: Distinct correlations were identified between the corneal hysteresis and corneal resistance factor values and the functional and structural parameters in the primary open-angle glaucoma and control groups. Corneal hysteresis and corneal resistance factor may have different roles in the pathophysiology of glaucoma.


RESUMO Objetivo: Investigar as relações entre (i) espessura da camada de fibras nervosas da retina, topografia do nervo óptico e parâmetros do campo visual e (ii) propriedades biomecânicas da córnea, em controles normais e pacientes com hiperten são ocular e glaucoma primário de ângulo aberto. Métodos: Este estudo observacional, transversal, incluiu 68 olhos com glaucoma primário de ângulo aberto, 99 olhos com hipertensão ocular e 133 olhos controle. As propriedades biomecânicas da córnea, as características topográficas da cabeça do nervo óptico, a espessura da camada de fibras nervosas da retina e os campos visuais foram avaliados em todos os casos. As propriedades biomecânicas da córnea, a espessura da camada de fibras nervosas da retina e as características topográficas da cabeça do nervo óptico foram comparadas entre os grupos. As associações entre medidas estruturais e funcionais de danos glaucomatosos e fatores biomecânicos da córnea também foram avaliadas. Resultados: Valores de histerese corneana e da resistência corneana foram significativamente menores nos grupos com glaucoma primário de ângulo aberto e hipertensão ocular em com paração ao grupo controle, mas não houve diferenças significativas entre os grupos de glaucoma primário de ângulo aberto e hipertensão ocular. No grupo com hipertensão ocular, não foram observadas associações entre histerese da córnea e o fator de resistência corneana com os valores e os parâmetros estruturais e funcionais. No grupo com glaucoma primário de ângulo aberto foram observadas correlações positivas entre os valores de histerese corneana e a espessura a camada de fibras nervosas da retina (p<0,01, r=0,27), espessura média da camada de fibras nervosas da retina (p<0,01, r=0,33) e desvio médio (p<0,01, r=0,26), e correlações negativas entre o os valores do fator de resistência da córnea e a área de escavação (p<0,01, r=-0,39), a relação escavação/disco (p=0,02, r=-0,28), a relação copo-para-disco linear (p=0,02, r=-0,28) e a forma da escavação (p=0,03, r=-0,26). No grupo controle, correlações foram detectadas entre a histerese da córnea e área de escavação (p=0,03, r=0,19), relação escavação/disco (p=0,01, r=0,21) e relação copo-para-disco linear (p=0,01, r=0,22). Conclusões: Correlações distintas foram identificadas entre histerese da córnea e os valores de resistência da córnea e os parâmetros funcionais e estruturais nos grupos de glaucoma primário de ângulo aberto e controle. A histerese da córnea e o fator de resistência da córnea podem ter diferentes papéis na fisiopatologia do glaucoma.


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Retina/patologia , Glaucoma de Ângulo Aberto/patologia , Hipertensão Ocular/patologia , Córnea/patologia , Fibras Nervosas/patologia , Valores de Referência , Retina/fisiopatologia , Fenômenos Biomecânicos , Campos Visuais/fisiologia , Estudos de Casos e Controles , Modelos Lineares , Glaucoma de Ângulo Aberto/fisiopatologia , Hipertensão Ocular/fisiopatologia , Estudos Transversais , Córnea/fisiopatologia , Pressão Intraocular
20.
Braz J Psychiatry ; 42(3): 309-313, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32022160

RESUMO

OBJECTIVE: To compare intraocular pressure (IOP) and macular, retinal nerve fiber layer (RNFL), and ganglion cell layer (GCL) thicknesses in treatment-naive children with attention-deficit/hyperactivity disorder (ADHD), children with ADHD on regular methylphenidate (MPH) treatment for at least 3 months, and healthy controls. METHODS: A total of 58 treatment-naive children with ADHD, 45 children with ADHD on regular MPH treatment, and 44 healthy controls were enrolled in this study. All participants underwent a comprehensive eye examination. Optical coherence tomography (OCT) was used to assess global RNFL thickness, central macular thickness, and GCL thickness in both eyes. RESULTS: Separate univariate analysis of covariance (ANCOVA) on the outcome variables revealed a significant difference among the research groups with respect to IOP in the left eye. Post-hoc univariate analyses indicated that left IOP was significantly higher in children with ADHD under MPH treatment than among healthy controls. However, global RNFL thickness, central macular thickness, and GCL thickness of both eyes, as well as IOP in the right eye, were not significantly different across groups. CONCLUSION: Further longitudinal follow-up studies are needed to determine whether MPH treatment has any effect on IOP or OCT findings.


Assuntos
Transtorno do Deficit de Atenção com Hiperatividade/patologia , Transtorno do Deficit de Atenção com Hiperatividade/fisiopatologia , Pressão Intraocular/fisiologia , Macula Lutea/patologia , Fibras Nervosas/patologia , Células Ganglionares da Retina/patologia , Adolescente , Análise de Variância , Estudos de Casos e Controles , Criança , Feminino , Humanos , Masculino , Valores de Referência , Retina/patologia , Tomografia de Coerência Óptica
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