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1.
Medicine (Baltimore) ; 99(7): e19126, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32049829

RESUMO

Structural differences have been reported between primary open angle glaucoma (POAG) and normal tension glaucoma (NTG), and biomechanical differences between POAG and NTG may account for why NTG patients are more vulnerable to lower intraocular pressure (IOP). This study compared the biomechanical properties of POAG and NTG patients using the Corvis scheimpflug technology (ST) non-contact Scheimpflug-based tonometer, and determined the factors associated with these properties.In this retrospective cross-sectional study, 46 eyes with POAG, 54 eyes with NTG, and 61 control eyes were included. A non-contact Scheimpflug-based tonometer was used to examine and compare the corneal biomechanical responses in the POAG, NTG, and normal groups. We used univariate and multivariate regression analyses to determine the factors associated with the deformation amplitude in each group.Baseline characteristics, including age, IOP, spherical equivalent, keratometry, axial length, and central corneal thickness, were similar among the 3 groups. Severity of glaucoma, as measured by mean deviation, was similar between POAG and NTG groups. Applanation 1 velocity and deformation amplitude were significantly smaller in POAG (0.13 ±â€Š0.02 and 1.06 ±â€Š0.14, respectively) than NTG (0.14 ±â€Š0.01 and 1.13 ±â€Š0.11, respectively) and normal groups (0.14 ±â€Š0.02 and 1.13 ±â€Š0.10, respectively). Radius of curvature was significantly larger in the POAG group compared to the normal group. In normal controls, IOP and keratometry were significant factors related to deformation amplitude. In POAG eyes, IOP was a statistically significant predictor of deformation amplitude. In NTG eyes, however, IOP , keratometry, and axial length were statistically significant predictors of deformation amplitude.POAG eyes showed less deformable corneas compared to NTG and normal controls. IOP was significantly correlated with deformation amplitude in all groups. However, axial length was positively correlated with deformation amplitude only in NTG eyes. Characterization of the differences in biomechanical properties between POAG and NTG may contribute to a better understanding of the underlying pathophysiologies associated with these diseases.


Assuntos
Córnea/fisiopatologia , Glaucoma de Ângulo Aberto/fisiopatologia , Glaucoma de Baixa Tensão/fisiopatologia , Adulto , Idoso , Estudos de Casos e Controles , Feminino , Humanos , Pressão Intraocular , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Tonometria Ocular/instrumentação
2.
Jpn J Ophthalmol ; 63(5): 402-409, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31367979

RESUMO

PURPOSE: To assess the efficacy and safety of filtration surgery using the EX-PRESS glaucoma filtration device in patients with normal-tension glaucoma (NTG). STUDY DESIGN: Prospective, single-arm, multicenter interventional case series. METHODS: Eyes with NTG underwent EX-PRESS implantation with or without cataract surgery. The efficacy and safety were assessed at 1 day; 1 and 2 weeks; and 1, 3, 6, and 12 months after surgery. The main outcome measure was reduction in intraocular pressure (IOP) from baseline at 3, 6, and 12 months after surgery. Safety assessments included adverse event incidence, postoperative inflammation, and corneal endothelial cell density. RESULTS: Thirty-two Japanese patients (37 eyes) with NTG were enrolled. The mean IOP decreased from 14.8 ± 2.3 mmHg at baseline to 10.0 ± 3.1 mmHg at 12 months after surgery (mean reduction 4.9 ± 4.2 mmHg [31.1%]; P < .0001). IOP-lowering medication use decreased from a mean of 3.3 medications per eye before surgery to 0.1 medications per eye at 12 months after surgery. IOP reductions > 20% were achieved by 61.5% of the eyes at 12 months. Adverse events were typical for filtration procedures, and none was deemed device-related. Postoperative inflammation was mild and self-limiting. The mean corneal endothelial cell density had decreased by 3.3% at 12 months after surgery. CONCLUSION: The EX-PRESS glaucoma filtration device is safe and effective for filtration surgery in patients with NTG, providing mean IOP reduction consistent with recommendations based on the Collaborative NTG Study.


Assuntos
Cirurgia Filtrante/métodos , Implantes para Drenagem de Glaucoma , Pressão Intraocular/fisiologia , Glaucoma de Baixa Tensão/cirurgia , Acuidade Visual , Feminino , Seguimentos , Humanos , Glaucoma de Baixa Tensão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Tempo , Resultado do Tratamento
3.
Graefes Arch Clin Exp Ophthalmol ; 257(9): 1963-1970, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31209566

RESUMO

PURPOSE: In order to clarify the association between peripapillary vascular changes and disc hemorrhage (DH) occurrences over time, we analyzed the density of radial peripapillary capillary (RPC) and clinical parameters during follow-up periods in patients with normal-tension glaucoma (NTG). METHODS: Seventy-seven eyes of 77 NTG patients were subjected to analysis. We selected patients who had an initial optical coherence tomography angiography (OCTA) scan in 2015 and who had another OCTA scan in 2018 with both OCTA scans showing good-quality images. We investigated the relationships between DH occurrence and each of the following parameters: RPC density, circumpapillary retinal nerve fiber layer (cpRNFL) thickness slope and total deviation (TD) slope. RESULTS: In the period between the initial and final OCTA, we categorized the patients into 53 sides with DH (DH group) and 101 sides without DH (non-DH group). The ΔRPC density of sides with DH was significantly greater than that of sides without DH (DH, - 4.42 ± 6.43%; without DH, - 2.48 ± 5.29%; p = 0.0469). The cpRNFL thickness slope of sides with DH was significantly faster than that of sides without DH (DH, - 2.85 ± 3.17; without DH, - 0.74 ± 2.46 µm/y; p < 0.0001). The TD slope of sides with DH was significantly faster than that of sides without DH (DH, - 0.50 ± 0.77; without DH, - 0.22 ± 0.53 dB/y; p = 0.0163). As DH occurrence increased, the RPC density significantly decreased (r = -0.255, p = 0.0014). Stepwise multiple regression analysis to identify factors influencing RPC changes showed that frequency of DH (ß = - 0.224, p = 0.008) and central corneal thickness (ß = - 0.220, p = 0.009) were significantly associated with RPC changes. CONCLUSIONS: DH occurrence may prompt the structural and vascular deterioration of NTG.


Assuntos
Angiofluoresceinografia/métodos , Pressão Intraocular , Glaucoma de Baixa Tensão/diagnóstico , Disco Óptico/irrigação sanguínea , Células Ganglionares da Retina/patologia , Hemorragia Retiniana/diagnóstico , Tomografia de Coerência Óptica/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Capilares/patologia , Feminino , Seguimentos , Fundo de Olho , Humanos , Glaucoma de Baixa Tensão/complicações , Glaucoma de Baixa Tensão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Fibras Nervosas/patologia , Hemorragia Retiniana/etiologia , Hemorragia Retiniana/fisiopatologia , Vasos Retinianos/patologia , Estudos Retrospectivos , Campos Visuais
4.
Invest Ophthalmol Vis Sci ; 60(7): 2423-2430, 2019 06 03.
Artigo em Inglês | MEDLINE | ID: mdl-31158274

RESUMO

Purpose: To investigate intereye differences in lamina cribrosa (LC) morphology in normal tension glaucoma (NTG) patients with unilateral damage. Methods: A total of 152 eyes of 76 treatment-naive NTG patients with unilateral damage from the ongoing Investigating Glaucoma Progression Study were included. Optic nerve heads were scanned using enhanced-depth spectral-domain optical coherence tomography. The magnitude of the LC curve and LC position were assessed by measuring the LC curve index (LCCI) and LC depth (LCD), respectively, at seven locations spaced equidistantly across the vertical optic disc diameter. LCCI and LCD were compared between glaucomatous and fellow healthy eyes. Results: Eyes with NTG had larger average LCCI and LCD than contralateral healthy eyes (for both P < 0.002). The LCCI was greater in the glaucomatous eyes at all seven locations (P < 0.001). Univariate conditional logistic regression analysis showed that higher baseline intraocular pressure (P = 0.010), deeper LCD (P = 0.007), and larger LCCI (P < 0.001) were significantly associated with the presence of glaucoma. In multivariate analysis, only larger LCCI was significantly associated with the presence of glaucoma (P < 0.001). Conclusions: Glaucomatous eyes have more steeply curved LC than fellow healthy eyes. This finding suggests that LC undergoes significant remodeling in NTG eyes.


Assuntos
Glaucoma de Baixa Tensão/diagnóstico , Disco Óptico/patologia , Doenças do Nervo Óptico/diagnóstico , Idoso , Estudos Transversais , Feminino , Gonioscopia , Humanos , Pressão Intraocular/fisiologia , Glaucoma de Baixa Tensão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Disco Óptico/diagnóstico por imagem , Doenças do Nervo Óptico/fisiopatologia , Estudos Prospectivos , Tomografia de Coerência Óptica/métodos , Tonometria Ocular , Acuidade Visual/fisiologia , Testes de Campo Visual , Campos Visuais/fisiologia
5.
Ophthalmic Res ; 62(1): 46-54, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31104053

RESUMO

OBJECTIVES: Evaluate the correlation between basal macular circulation and late structural damage in progressed high-tension glaucoma (HTG) and normal-tension glaucoma (NTG) via optical coherence tomography angiography (OCTA). METHODS: Patients who received an OCTA examination were divided into progressed HTG, progressed NTG, and well-controlled HTG (control) groups. Superficial macular vessel density (SmVD), deep macular vessel density (DmVD), foveal avascular zone (FAZ), and flow area of the outer retina and choriocapillaris were obtained by one OCTA device. Associations between macular angiography and glaucoma parameters, including the visual field, retinal nerve fiber layer, and ganglion cell complex, were analyzed. RESULTS: A total of 60 eyes from 60 patients were enrolled. The progressed HTG and NTG groups had lower SmVD than the control group, while the progressed NTG group had lower DmVD and a larger FAZ than the control group. The flow area of the outer retina in the progressed HTG group was lower than that of the control. A significant correlation between SmVD and glaucoma parameters was found in the progressed HTG group, while a similar correlation between SmVD and DmVD to glaucoma parameters was observed in the progressed NTG group. CONCLUSION: The progressed HTG and NTG patients showed an impaired vascular intake before significant disease development compared to well-controlled cases.


Assuntos
Glaucoma/fisiopatologia , Macula Lutea/irrigação sanguínea , Idoso , Análise de Variância , Estudos de Casos e Controles , Feminino , Angiofluoresceinografia , Humanos , Glaucoma de Baixa Tensão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Vasos Retinianos/patologia , Estudos Retrospectivos , Tomografia de Coerência Óptica
6.
Med Hypotheses ; 127: 97-99, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31088658

RESUMO

Glaucoma is a leading cause of irreversible blindness worldwide. Primary open-angle glaucoma, the most common type, is characterized by progressive degeneration of retinal ganglion cells and their axons in the optic nerve, resulting in progressive deterioration of visual fields. The optic nerve head is generally considered to be the primary site of axonal injury in glaucoma. Although the pathophysiology of glaucomatous optic neuropathy is not well understood, elevated intraocular pressure is considered the most important modifiable risk factor. However, in normal-tension glaucoma, intraocular pressure is not elevated and thus other risk factors must also be involved in the optic neuropathy of primary open-angle glaucoma. Several studies reported significantly lower intracranial pressure in patients with glaucoma compared with healthy subjects, suggesting that low intracranial pressure may result in a high pressure difference across the lamina cribrosa, influencing the physiology and pathophysiology of the optic nerve head by the effect of a mechanical force. Moreover, a rapidly evolving literature suggests the existence of an 'ocular glymphatic system'. This opens up new ways to understand the mechanisms underlying a range of ocular diseases such as glaucoma. In the present paper, I hypothesize that an imbalance between intraocular pressure and intracranial pressure, apart from generating mechanical forces at the lamina cribrosa, may lead to a dangerous interplay between ocular fluid and cerebrospinal fluid resulting in impaired cerebrospinal fluid entry into the optic nerve subarachnoid space and optic nerve perivascular spaces, and the perivascular space surrounding the central retinal artery in particular, thereby inhibiting glymphatic clearance of waste products from the retrobulbar or retrolaminar portion of the optic nerve. Should further research demonstrate that the proposed viewpoint is largely correct, it would hold great potential for our understanding of glaucomatous optic nerve damage and would have important implications for diagnosis and therapy of this devastating disorder.


Assuntos
Líquidos Corporais , Líquido Cefalorraquidiano , Glaucoma de Ângulo Aberto/complicações , Glaucoma/fisiopatologia , Pressão Intraocular , Doenças do Nervo Óptico/fisiopatologia , Nervo Óptico/fisiopatologia , Glaucoma/líquido cefalorraquidiano , Humanos , Pressão Intracraniana , Glaucoma de Baixa Tensão/fisiopatologia , Neurite Óptica/fisiopatologia , Células Ganglionares da Retina/metabolismo , Campos Visuais
7.
Acta Ophthalmol ; 97(7): e962-e967, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31016882

RESUMO

BACKGROUND: To test the ability of the newly calculated Dresden biomechanical glaucoma factor (DBGF) based on dynamic corneal response (DCR) deformation and corneal thickness parameters, to discriminate between healthy and normal pressure glaucoma (NPG) eyes. METHODS: Seventy healthy and 70 NPG patients of Caucasian origin were recruited for this multicentre cross-sectional pilot study, which included both eyes for analysis. Logistic regression analysis with generalized estimating equation (GEE) models to account for correlations between eyes and a threefold cross-validation were performed to determine the optimal combination of Corvis ST parameters in order to separate normal from NPG eyes. RESULTS: The DBGF was calculated using 5 Corvis ST parameters, which showed the best discrimination power: deformation amplitude ratio progression, highest concavity time, pachymetry slope, the biomechanically corrected intraocular pressure and pachymetry. In a threefold cross-validation, the receiver operating characteristic (ROC) curve confirmed an area under the curve (AUC) of 0.814 with a sensitivity of 76% and a specificity of 77% using a logit cut-off value of a DBGF = 0.5. CONCLUSION: The DBGF shows to be sensitive and specific to discriminate healthy from NPG eyes. Since diagnosis of NPG is often challenging, the DBGF may help with the differential diagnosis of NPG in daily clinical practice. Therefore, it might be considered as a new possible screening method for NPG.


Assuntos
Córnea/fisiopatologia , Pressão Intraocular/fisiologia , Glaucoma de Baixa Tensão/fisiopatologia , Idoso , Fenômenos Biomecânicos , Córnea/patologia , Paquimetria Corneana , Topografia da Córnea , Estudos Transversais , Feminino , Seguimentos , Humanos , Glaucoma de Baixa Tensão/diagnóstico , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Estudos Prospectivos , Curva ROC , Tonometria Ocular
8.
JAMA Ophthalmol ; 137(5): 559-563, 2019 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-30816940

RESUMO

Importance: Mutations in the myocilin (MYOC) gene are the most common molecularly defined cause of primary open-angle glaucoma that typically occurs in patients with high intraocular pressures (IOP). One MYOC mutation, p.Gln368Ter, has been associated with as many as 1.6% of primary open-angle glaucoma cases that had a mean maximum recorded IOP of 30 mm Hg. However, to our knowledge, the role of the p.Gln368Ter mutation in patients with normal-tension glaucoma (NTG) with an IOP of 21 mm Hg or lower has not been investigated. Objective: To evaluate the role of the p.Gln368Ter MYOC mutation in patients with NTG. Design, Setting, and Participants: In this case-control study of the prevalence of the p.Gln368Ter mutation in patients with NTG, cohort 1 was composed of 772 patients with NTG and 2152 controls from the United States (Iowa, Minnesota, and New York) and England and cohort 2 was composed of 561 patients with NTG and 2606 controls from the Massachusetts Eye and Ear Infirmary and the NEIGHBORHOOD consortium. Genotyping was conducted using real-time polymerase chain reaction that was confirmed with Sanger sequencing, the imputation of genome-wide association study data, or an analysis of whole-exome sequence data. Data analysis occurred between April 2007 and April 2018. Main Outcomes and Measures: Comparison of the frequency of the p.Gln368Ter MYOC mutation between NTG cases and controls with the Fisher exact test. Results: Of 6091 total participants, 3346 (54.9%) were women and 5799 (95.2%) were white. We detected the p.Gln368Ter mutation in 7 of 772 patients with NTG (0.91%) and 7 of 2152 controls (0.33%) in cohort 1 (P = .03). In cohort 2, we detected the p.Gln368Ter mutation in 4 of 561 patients with NTG (0.71%) and 10 of 2606 controls (0.38%; P = .15). When the cohorts were analyzed as a group, the p.Gln368Ter mutation was associated with NTG (odds ratio, 2.3; 95% CI, 0.98-5.3; P = .04). Conclusions and Relevance: In cohorts 1 and 2, the p.Gln368Ter mutation in MYOC was found in patients with IOPs that were 21 mm Hg or lower (NTG), although at a frequency that is lower than previously detected in patients with higher IOP. These data suggest that the p.Gln368Ter mutation may be associated with glaucoma in patients with normal IOPs as well as in patients with IOPs that are greater than 21 mm Hg.


Assuntos
Proteínas do Citoesqueleto/genética , Proteínas do Olho/genética , Glicoproteínas/genética , Glaucoma de Baixa Tensão/genética , Mutação , Idoso , Estudos de Casos e Controles , Feminino , Humanos , Pressão Intraocular/fisiologia , Glaucoma de Baixa Tensão/fisiopatologia , Masculino , Pessoa de Meia-Idade
9.
Invest Ophthalmol Vis Sci ; 60(4): 889-900, 2019 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-30835290

RESUMO

Purpose: To compare the visual field (VF) progression among high tension glaucoma (HTG), primary angle closure glaucoma (PACG), and normal tension glaucoma (NTG) subjects in routine clinical care. Methods: All patients had ≥5 VF tests using HFA, 24-2, SITA-standard strategy. We compared the progression between glaucoma subtypes after matching the VFs for baseline severity (mean deviation [MD]) and the age at presentation. Global VF progression was evaluated by linear regression analysis (LRA) of MD. For local VF progression, scotoma expansion (SE) defined as appearance of new scotoma and scotoma deepening (SD) defined by pointwise LRA were calculated. SE and SD were analyzed in three VF zones: superior arcuate (SA), inferior arcuate (IA), and central (C). Results: A total of 310 HTG, 304 PACG, and 165 NTG eyes were included. When VFs were matched by baseline MD, a greater number (n = 20/76) of eyes with HTG showed significant progression compared to PACG (n = 9/76; P = 0.04). The number of progressing eyes were not significantly different between HTG and NTG (n = 11/76; P = 0.10) and between NTG and PACG (P = 0.65). When the baseline VFs were matched by age, the number of eyes showing significant progression were similar in all the subtypes. SA zone in HTG and NTG showed greater SE and SD compared to other zones (P < 0.05), whereas IA zone in PACG showed greater SE and SD compared to other zones (P < 0.05). Conclusions: In our cohort of treated primary glaucoma with matched baseline severity, a greater proportion of HTG eyes progressed faster compared to PACG. SA zone in HTG and NTG and IA zone in PACG showed greater VF progression.


Assuntos
Glaucoma de Ângulo Fechado/diagnóstico , Glaucoma de Ângulo Aberto/diagnóstico , Glaucoma de Baixa Tensão/diagnóstico , Escotoma/diagnóstico , Campos Visuais/fisiologia , Adulto , Idoso , Progressão da Doença , Feminino , Cirurgia Filtrante , Seguimentos , Glaucoma de Ângulo Fechado/fisiopatologia , Glaucoma de Ângulo Fechado/cirurgia , Glaucoma de Ângulo Aberto/fisiopatologia , Glaucoma de Ângulo Aberto/cirurgia , Humanos , Pressão Intraocular/fisiologia , Iridectomia , Terapia a Laser , Glaucoma de Baixa Tensão/fisiopatologia , Glaucoma de Baixa Tensão/cirurgia , Masculino , Pessoa de Meia-Idade , Fibras Nervosas/patologia , Disco Óptico/patologia , Células Ganglionares da Retina/patologia , Estudos Retrospectivos , Escotoma/fisiopatologia , Tonometria Ocular , Testes de Campo Visual
10.
Asia Pac J Ophthalmol (Phila) ; 8(1): 22-29, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30773853

RESUMO

PURPOSE: To determine if a novel biomechanical parameter, corneal applanation velocity, as measured by the Corvis ST, is associated with a diagnosis of normal-tension glaucoma (NTG). DESIGN: Prospective, cross-sectional study. METHODS: Study and control subjects were recruited from the ophthalmology clinic of a university teaching hospital in Hong Kong over an 8-week period in 2013. A total of 80 eyes with NTG diagnosis and 155 healthy eyes randomly selected to be in the control group were included in the final analysis. All subjects underwent corneal biomechanical testing with the Oculus Corvis ST non-contact tonometer. Logistic regression analysis adjusted for age and central corneal thickness was conducted to assess the relationship between inward and outward applanation velocity and the risk of NTG. Secondary outcome variables included corneal applanation time, length, amplitude, and highest concavity. RESULTS: Inward applanation velocity was faster in the NTG eyes (0.15 ± 0.02 m/s) than in the control eyes (0.14 ± 0.02 m/s) (P = 0.016). The odds ratio for a 0.01 m/s increase in inward applanation velocity when comparing NTG eyes with control eyes adjusted for age and central corneal thickness was 1.15 (95% confidence interval, 1.03-1.30) (P = 0.016). There was no evidence that outward applanation velocity or any secondary corneal biomechanical variable differed between the NTG and control eyes. CONCLUSIONS: Normal-tension glaucoma eyes demonstrated a small, statistically significant faster corneal inward applanation velocity than normal control eyes.


Assuntos
Pressão Intraocular/fisiologia , Glaucoma de Baixa Tensão/fisiopatologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Fenômenos Biomecânicos , Estudos de Casos e Controles , Paquimetria Corneana , Estudos Transversais , Feminino , Hong Kong , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Tonometria Ocular/métodos , Adulto Jovem
11.
Invest Ophthalmol Vis Sci ; 60(1): 442-450, 2019 01 02.
Artigo em Inglês | MEDLINE | ID: mdl-30703209

RESUMO

Purpose: Aging and glaucoma both result in contrast processing deficits. However, it is unclear the extent to which these functional deficits arise from retinal or post-retinal neuronal changes. This study aims to disentangle the effects of healthy human aging and glaucoma on retinal and post-retinal contrast processing using visual electrophysiology. Methods: Steady-state pattern electroretinograms (PERG) and pattern visual evoked potentials (PVEP) were simultaneously recorded across a range of contrasts (0%, 4%, 9%, 18%, 39%, 73%, 97%; 0.8° diameter checks, 31° diameter checkerboard) in 13 glaucoma patients (67 ± 6 years), 15 older (63 ± 8 years) and 14 younger adults (27 ± 3 years). PERG and PVEP contrast response functions were fit with a linear and saturating hyperbolic model, respectively. PERG and PVEP magnitude, timing (phase), and model fit parameters (slope, semi-saturation constant) were compared between groups. Results: PERG responses were reduced and delayed in older adults relative to younger adults, and further reduced and delayed in glaucoma patients across all contrasts. PVEP signals were also reduced and delayed in glaucoma patients, relative to age-similar (older) controls. However, despite having reduced PERG magnitudes, older adults did not demonstrate reduced PVEP magnitudes. Conclusions: Older adults with healthy vision demonstrate reduced magnitude and delayed timing in the PERG that is not reflected in the PVEP. In contrast, glaucoma produces functional deficits in both PERG and PVEP contrast response functions. Our results suggest that glaucomatous effects on contrast processing are not a simple extension of those that arise as part of the aging process.


Assuntos
Envelhecimento/fisiologia , Sensibilidades de Contraste/fisiologia , Eletrorretinografia , Potenciais Evocados Visuais/fisiologia , Glaucoma de Ângulo Aberto/fisiopatologia , Glaucoma de Baixa Tensão/fisiopatologia , Retina/fisiopatologia , Adulto , Idoso , Eletrofisiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Células Ganglionares da Retina/fisiologia , Campos Visuais , Adulto Jovem
12.
Eur J Ophthalmol ; 29(5): 516-523, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30255729

RESUMO

PURPOSE: Cataract surgeries have been shown to reduce intraocular pressure. We used a Sensimed Triggerfish® contact lens sensor to compare intraocular pressure levels and their fluctuation between before and after cataract surgeries in patients with normal-tension glaucoma. METHODS: This was a prospective open-label study. Thirteen patients with normal-tension glaucoma were included. All patients underwent a 1-month washout and discontinued glaucoma medications during this study. In each eye, intraocular pressure fluctuations over 24 h were measured with the contact lens sensor before and at 3 months after the cataract surgery. We compared intraocular pressure levels and their fluctuation between before and after cataract surgeries. We used two approaches to evaluate the amplitude of intraocular pressure fluctuations: dual-harmonic regression analysis, and measurement of the difference between the maximum and the minimum value. RESULTS: The mean pre-operative intraocular pressure was 14.7 ± 2.2 mm Hg and mean post-operative intraocular pressure was 11.4 ± 2.2 mm Hg. Cataract surgery significantly decreased intraocular pressure (p = 0.0005). In both methods, the post-operative fluctuations in intraocular pressure over 24 h were significantly smaller than their pre-operative counterparts (dual-harmonic regression analysis: p = 0.0171; difference between the maximum and the minimum: p = 0.0398). CONCLUSION: Cataract surgery decreased both intraocular pressure values and intraocular pressure fluctuations in normal-tension glaucoma patients.


Assuntos
Pressão Intraocular/fisiologia , Implante de Lente Intraocular , Glaucoma de Baixa Tensão/fisiopatologia , Facoemulsificação , Idoso , Lentes de Contato , Feminino , Humanos , Glaucoma de Baixa Tensão/diagnóstico , Masculino , Período Pós-Operatório , Período Pré-Operatório , Estudos Prospectivos , Pseudofacia/fisiopatologia , Refração Ocular/fisiologia , Tonometria Ocular/instrumentação , Acuidade Visual/fisiologia
13.
Acta Ophthalmol ; 97(1): e50-e56, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30225863

RESUMO

PURPOSE: Vascular factors have been suggested to influence the development and progression of glaucoma. They are thought to be especially relevant for normal-tension glaucoma (NTG) patients. We aim to investigate which vascular factors, including advanced vascular examinations, better describe patients with NTG comparing to those with primary open-angle glaucoma (POAG). METHODS: The Leuven Eye Study database (182 NTG and 202 POAG patients; similar structural and functional damage) was used to compute three multivariate logistic regression models: a conventional model (conventional parameters only, including vascular-related self-reported phenomena, such as migraine or peripheral vasospasm); an advanced vascular model (advanced vascular parameters only: colour Doppler imaging (CDI), retinal oximetry, ocular pulse amplitude and choroidal thickness); and a global model, in which both types of parameters were allowed. Receiver operating characteristic (ROC) curves and corresponding areas under the curve (AUC) were calculated and compared between models. RESULTS: Patients with NTG had a higher resistive index and lower early systolic acceleration (ESA) in their retrobulbar vessels and a smaller arteriovenous retinal oxygen saturation difference. The global model (AUC 0.743) showed a significantly better discriminative ability when compared to either the conventional (AUC 0.687, p = 0.049) or the advanced vascular (AUC 0.677, p = 0.005) models. Also, the conventional and the advanced vascular models showed a similar discriminative ability (p = 0.823). CONCLUSION: Patients with NTG have more signs of vascular dysfunction. Clinical conventional parameters, such as asking simple vascular-related questions, combined with advanced vascular examinations provide information to better understand the value that non-IOP-related factors play in NTG.


Assuntos
Velocidade do Fluxo Sanguíneo/fisiologia , Glaucoma de Ângulo Aberto/diagnóstico , Pressão Intraocular/fisiologia , Glaucoma de Baixa Tensão/diagnóstico , Células Ganglionares da Retina/patologia , Vasos Retinianos/diagnóstico por imagem , Tomografia de Coerência Óptica/métodos , Idoso , Diagnóstico Diferencial , Progressão da Doença , Feminino , Glaucoma de Ângulo Aberto/fisiopatologia , Humanos , Glaucoma de Baixa Tensão/fisiopatologia , Masculino , Fibras Nervosas/patologia , Curva ROC , Vasos Retinianos/fisiopatologia , Tonometria Ocular , Ultrassonografia Doppler em Cores/métodos
14.
Am J Ophthalmol ; 199: 111-119, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30336130

RESUMO

PURPOSE: To determine whether a machine learning technique called Kalman filtering (KF) can accurately forecast future values of mean deviation (MD), pattern standard deviation, and intraocular pressure for patients with normal tension glaucoma (NTG). DESIGN: Development and testing of a forecasting model for glaucoma progression. METHODS: We parameterized and validated a KF (KF-NTG) to forecast MD, pattern standard deviation, and intraocular pressure at 24 months into the future using 263 eyes of 263 Japanese patients with NTG. We determined the proportion of patients with MD forecasts within 0.5, 1.0, and 2.5 dBs of the actual values and calculated the root mean squared error (RMSE) for each forecast. We compared KF-NTG with a previously published KF model calibrated using patients with high-tension open-angle glaucoma (KF-HTG) and to 3 conventional forecasting algorithms. RESULTS: The 263 patients with NTG had mean ± standard deviation age of 63.4 ± 10.5 years. KF-NTG forecasted MD values 24 months ahead within 0.5, 1.0, and 2.5 dBs of the actual value for 78 eyes (32.2%), 122 eyes (50.4%), and 211 eyes (87.2%), respectively. The proportion of eyes with MD values forecasted within 2.5 dB of the actual value for the KF-NTG (87.2%) were similar to KF-HTG (86.0%) and the null model (86.4%), and much better than the 2 linear regression-based models (72.7-74.0%; P < .001). When forecasting MD, KF-NTG (RMSE = 2.71) and KF-HTG (RMSE = 2.68) achieved lower RMSE than the other 3 forecasting models (RMSE = 2.81-3.90), indicating better performance. CONCLUSION: As observed previously for patients with HTG, KF can also effectively forecast disease trajectory for many patients with NTG.


Assuntos
Previsões , Glaucoma de Baixa Tensão/diagnóstico , Aprendizado de Máquina/tendências , Idoso , Algoritmos , Grupo com Ancestrais do Continente Asiático/etnologia , Feminino , Humanos , Pressão Intraocular/fisiologia , Japão/epidemiologia , Glaucoma de Baixa Tensão/etnologia , Glaucoma de Baixa Tensão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Testes de Campo Visual , Campos Visuais/fisiologia
15.
J Glaucoma ; 28(1): 42-50, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30300303

RESUMO

PURPOSE: To investigate the effects of monocular visual field loss severity on binocular visual field (BVF) loss in primary angle-closure glaucoma, primary open-angle glaucoma, and normal tension glaucoma patients. MATERIALS AND METHODS: In this observational cross-sectional study, 250 glaucoma patients and 31 healthy participants were assigned to groups according to the stage of monocular visual field loss in both eyes; normal, early, moderate, or severe. BVF assessments were determined via integrated visual field and Esterman binocular visual evaluations. Monocular and BVF parameters were compared within and among groups. RESULTS: In patients with one eye at normal or early stage and the other at severe stage, the average integrated mean deviations (MDs) were [mean (SD)], -1.67 (1.39), and -3.27 (2.05) dB, respectively, and the average Esterman scores were >95% [99.17% (1.89%), 96.08% (3.99%), respectively]. Where both eyes had progressed to moderate or severe damage (moderate/moderate, moderate/severe, or severe/severe), the average integrated MDs were worse than -6 dB, and the mean Esterman scores in the moderate/moderate and the moderate/severe damage groups were still >90% [94.20% (5.96%), 94.32% (4.95%), respectively], but it dropped rapidly from >90% to 68.44% (26.27%) when both eyes were at severe stage. CONCLUSIONS: The BVF can remain relatively intact provided one eye is at the normal or early stage. Significant BVF defects measured by integrated MD were evident when both eyes had progressed to moderate or severe stage, and significant Esterman BVF defects were only detected when both eyes had advanced to a severe stage.


Assuntos
Glaucoma de Ângulo Fechado/fisiopatologia , Glaucoma de Ângulo Aberto/fisiopatologia , Glaucoma de Baixa Tensão/fisiopatologia , Transtornos da Visão/fisiopatologia , Visão Binocular/fisiologia , Visão Monocular/fisiologia , Campos Visuais/fisiologia , Adulto , Idoso , Estudos Transversais , Feminino , Glaucoma de Ângulo Fechado/diagnóstico , Glaucoma de Ângulo Aberto/diagnóstico , Humanos , Pressão Intraocular/fisiologia , Glaucoma de Baixa Tensão/diagnóstico , Pessoa de Meia-Idade , Acuidade Visual/fisiologia , Testes de Campo Visual
19.
Int Ophthalmol ; 39(1): 199-201, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29256166

RESUMO

PURPOSE: To report a case of low tension neovascular glaucoma in ocular ischemic syndrome. METHODS: An elderly man presenting with vision loss after an episode of hemiparesis was investigated to look for the cause of vision loss and treated. RESULTS: Fluorescein angiography demonstrated poor uveal perfusion and treatment with panretinal photocoagulation led to rapid closure of the angle. CONCLUSION: This case highlights the typical ophthalmic features of ocular ischemic syndrome and emphasizes the necessity of patient education and prognostication.


Assuntos
Doenças da Coroide/etiologia , Corioide/irrigação sanguínea , Glaucoma Neovascular/etiologia , Pressão Intraocular/fisiologia , Isquemia/complicações , Glaucoma de Baixa Tensão/etiologia , Vasos Retinianos/diagnóstico por imagem , Corioide/diagnóstico por imagem , Doenças da Coroide/diagnóstico , Doenças da Coroide/fisiopatologia , Progressão da Doença , Angiofluoresceinografia , Fundo de Olho , Glaucoma Neovascular/diagnóstico , Glaucoma Neovascular/fisiopatologia , Humanos , Isquemia/diagnóstico , Glaucoma de Baixa Tensão/diagnóstico , Glaucoma de Baixa Tensão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Fluxo Sanguíneo Regional/fisiologia , Vasos Retinianos/fisiopatologia
20.
Rom J Ophthalmol ; 63(4): 346-353, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31915732

RESUMO

Purpose: To study the hemodynamic parameters in ophthalmic artery (OA) using color Doppler imaging in subjects with primary open-angle glaucoma (POAG), normal-tension glaucoma (NTG) and age matched normals. Methods: Sixty-eight eyes of 68 subjects (41 males and 27 females) constituted material for this prospective observational study. They were divided into three groups; Group A had 24 patients with POAG, Group B had 18 patients with NTG and Group C had 26 normal subjects. They underwent CDI of OA. The outcome variables were peak systolic velocity (PSV), end diastolic velocity (EDV), resistivity index (RI) and pulsatility index (PI). Data were compiled and analyzed using one-way ANOVA analysis. Results: The mean ± SD age of POAG patients, NTG patient and normal subjects was 59.95 ± 7.35, 58.11 ± 9.97 and 57.73 ± 5.39 years, respectively. The mean intra ocular pressure (IOP) was 29.8 ± 5.0, 15.9 ± 2.4 and 16.6 ± 1.7mm Hg in Group A, B and C, respectively. In group A, the mean PSV, EDV, RI and PI were 18.2 ± 3.80, 3.71 ± 1.40, 0.93 ± 0.12 and 2.8 ± 0.42. In group B, 26.6 ± 1.72, 4.93 ± 1.32, 0.84 ± 0.02 and 1.32 ± 0.20 and in group C, 35.4 ± 3.04, 8.08 ± 0.69, 0.77 ± 0.03 and 1.80 ± 0.17, respectively. All the values were found to be statistically significant (p < 0.05). Lower PSV and EDV were found in POAG and NTG patients, while RI was higher than in normal subjects. Conclusion: The hemodynamic parameters are significantly affected in POAG and NTG patients. The PSV and EDV are decreased and RI is increased. EDV is more sensitive for the assessment of hemodynamic changes.


Assuntos
Velocidade do Fluxo Sanguíneo/fisiologia , Glaucoma de Ângulo Aberto/fisiopatologia , Glaucoma de Baixa Tensão/fisiopatologia , Artéria Oftálmica/fisiopatologia , Fluxo Pulsátil/fisiologia , Diástole , Feminino , Seguimentos , Glaucoma de Ângulo Aberto/diagnóstico , Humanos , Glaucoma de Baixa Tensão/diagnóstico , Masculino , Pessoa de Meia-Idade , Artéria Oftálmica/diagnóstico por imagem , Estudos Prospectivos , Sístole , Ultrassonografia Doppler em Cores
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