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1.
Cesk Slov Oftalmol ; 77(1): 22-26, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33740864

RESUMO

AIMS: The aim of the work is to verify the necessity of full-field perimetry test in incipient glaucoma. MATERIAL AND METHODS: The study included group of 16 incipient hypertension glaucoma (HTG group) patients without obvious changes in visual field and control group of 10 patients with normal ocular findings and value 1.0 of visual acuity. In both groups, full-field perimetry test was performed followed by a glaucoma perimetry test (rapid threshold strategy in both cases). Evaluated parameters were pattern defect (PD) and overall defect (OD) using Pearsons correlation coefficient. RESULTS: Strong correlation coefficient between PD (r = 0.74) and OD (r = 0.63) of both perimetry test were found in HTG group. Moderate correlation of PD (r = 0.54) and strong correlation of OD (r = 0.64) in control group. CONCLUSION: Results of the study shows, that expected changes of peripheral visual field will be recorded first in HTG group, but opposite is true. Perimetry glaucoma test is for incipient glaucoma sufficient to document the course and the examination of glaucoma disease.


Assuntos
Glaucoma , Hipertensão , Hipertensão Ocular , Glaucoma/complicações , Glaucoma/diagnóstico , Humanos , Pressão Intraocular , Testes de Campo Visual , Campos Visuais
2.
Cesk Slov Oftalmol ; 77(1): 28-34, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33740865

RESUMO

PURPOSE: The aim of the study was to evaluate ocular surface and tear film in patients with pediatric (primary or secondary) unilateral glaucoma and compare results obtained from the treated eye and untreated healthy eye. METHODS: Patients with unilateral pediatric glaucoma, followed in the outpatient department of the Department of Ophthalmology, Motol University Hospital, were included in this study. Tear osmolarity, corneal epithelial thickness, lower tear meniscus area, Schirmer test, corneal fluorescein staining and tear break-up time test (TBUT) were evaluated in both healthy and treated eye. The Ocular Surface Disease Index (OSDI) was used to establish subjective impairment. The values obtained through testing the healthy and treated eye were compared. RESULTS: Thirteen patients met the inclusion criteria of the study. The mean age of the patients was 17.2 ± 8.1 years. There was statistically significant decrease in corneal epithelial thickness and TBUT in the treated eye (45.9 ± 5.3 µm, 6.0 ± 1.7 second resp.) compared to the healthy eye (50.2 ± 2.6 µm, 8.8 ± 3.2 second resp.; p = 0.0106, p = 0.0015 resp.). Fluorescein staining score of the ocular surface was higher in the treated eye (1.7 ± 2.1) than in the healthy eye (0.5 ± 0.8; p = 0.0243). We found no statistically significant difference in the other evaluated parameters between the treated and the healthy eyes. CONCLUSION: The results confirmed signs of ocular surface damage in treated eyes. The damage may be induced by chronic topical antiglaucoma therapy, but that could be a consequence of the previous ocular surgery as well. The possible damage of the ocular surface should be taken into account when selecting appropriate treatment in these patients.


Assuntos
Síndromes do Olho Seco , Glaucoma , Adolescente , Adulto , Criança , Estudos Transversais , Síndromes do Olho Seco/diagnóstico , Síndromes do Olho Seco/tratamento farmacológico , Humanos , Concentração Osmolar , Lágrimas , Adulto Jovem
3.
Zhonghua Yan Ke Za Zhi ; 57(3): 161-165, 2021 Mar 11.
Artigo em Chinês | MEDLINE | ID: mdl-33721955

RESUMO

Glaucoma is the leading cause of irreversible blindness worldwide. The Chinese Glaucoma Guidelines (2020) formulated important references and suggestions for the treatment of glaucoma, based on the basic national condition of China and considering the latest global progress. To fulfill their guiding effect on clinical work, publicity and promotion of the Guidelines should be intensified to prompt the communication and application. The ophthalmology specialists should pay attention to the quality assessment and reevaluation of the Guidelines regarding their reliability and applicability in clinical work, and promote the evidence-based practice of glaucoma. Continuous feedbacks from clinical practice would enable timely updates and improvement of the Guidelines, thus building a better evidence ecosystem and constantly optimizing the diagnosis and treatment of glaucoma in China. (Chin J Ophthalmol, 2021, 57:161-165).


Assuntos
Glaucoma , Oftalmologia , China , Ecossistema , Glaucoma/terapia , Humanos , Reprodutibilidade dos Testes
4.
Zhonghua Yan Ke Za Zhi ; 57(3): 166-170, 2021 Mar 11.
Artigo em Chinês | MEDLINE | ID: mdl-33721956

RESUMO

Primary glaucoma with cataract is a common eye disease in China, and surgery is the main treatment. With the continuous advance of medical technology, the choice of surgical methods is controversial, and there is still a lack of consensus with general guiding significance in China. In order to standardize the clinical treatment, Chinese Glaucoma Society has formulated this consensus after a serious discussion. This consensus is aiming at guiding clinical practice and putting forward instructive opinions on the operation methods, perioperative and follow-up management of different types and stages of primary glaucoma with cataract surgery indications. (Chin J Ophthalmol, 2021, 57:166-170).


Assuntos
Extração de Catarata , Catarata , Glaucoma , Catarata/terapia , China , Consenso , Glaucoma/cirurgia , Humanos
5.
Int J Nanomedicine ; 16: 1067-1081, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33603369

RESUMO

Background: Extracellular vesicles (EVs) are capable of manipulating cellular functions for the maintenance of biological homeostasis and disease progression, such as in glaucoma disease. These nano-particles carry a net negative surface charge under physiological conditions that can contribute to EVs:EVs interaction and their uptake by target cells. Purpose: To investigate the effect of glaucoma drugs on EVs physicochemical characters and the implications for their uptake by trabecular meshwork (TM) cells. Methods: TM or non-pigmented ciliary epithelium (NPCE) cells derived EVs were incubated with commercial anti-glaucoma formulation, Timolol maleate, Brinzolamide or Benzalkonium Cl and their size and zeta potential (ZP) and physical interactions of EVs derived from NPCE cells and TM cells were evaluated. The contribution of EVs interactions to up-take by TM cells was examined using fluorescence-activated cell sorting. Results: EVs size and ZP were affected by the ionic strength of the buffer rather than EVs type. Commercial glaucoma eye drops, including ß-blocker, α-2-agonist and prostaglandin analogs, reduced NPCE EVs ZP, whereas exposure of EVs to carbonic anhydrase inhibitor caused an increase in the ZP. A correlation was found between increased ZP values and increased NPCE EVs uptake by TM cells. We were able to show that Benzalkonium chloride stands behind this ZP effect and not Timolol or Brinzolamide. Conclusion: Altogether, our findings demonstrate that EVs size, surface membrane charge, and ionic strength of the surrounding have an impact on EVs:EVs interactions, which affect the uptake of NPCE EVs by TM cells.


Assuntos
Agonistas Adrenérgicos/farmacologia , Antagonistas Adrenérgicos beta/farmacologia , Células Epiteliais/fisiologia , Vesículas Extracelulares/fisiologia , Glaucoma/tratamento farmacológico , Soluções Oftálmicas/farmacologia , Malha Trabecular/fisiologia , Células Cultivadas , Células Epiteliais/efeitos dos fármacos , Glaucoma/patologia , Humanos , Malha Trabecular/efeitos dos fármacos
6.
BMJ Case Rep ; 14(2)2021 Feb 19.
Artigo em Inglês | MEDLINE | ID: mdl-33608341

RESUMO

A 61-year-old male patient presented with decreased vision and recurrent redness in his right eye since the past 4 years. He had been diagnosed elsewhere as HLA-B27 positive anterior uveitis and was on oral methotrexate and topical corticosteroids for recurrent disease. He was on maximal medical therapy for glaucoma. Examination showed prominent inferior corneal oedema with pigmented keratic precipitates and elevated intraocular pressure. He underwent combined trabeculectomy with mitomycin C and cataract surgery. The aqueous sample tested positive for cytomegalovirus. He responded well to oral valganciclovir with resolution of uveitis, the intraocular pressure was well controlled and the corneal oedema resolved completely.


Assuntos
Infecções por Citomegalovirus/complicações , Infecções por Citomegalovirus/diagnóstico , Erros de Diagnóstico , Epitélio Posterior/virologia , Glaucoma/complicações , Uveíte/complicações , Antivirais/uso terapêutico , Citomegalovirus/isolamento & purificação , Infecções por Citomegalovirus/tratamento farmacológico , Epitélio Posterior/efeitos dos fármacos , Epitélio Posterior/cirurgia , Antígeno HLA-B27 , Humanos , Masculino , Pessoa de Meia-Idade , Uveíte/diagnóstico , Uveíte/cirurgia , Valganciclovir/uso terapêutico
7.
MMW Fortschr Med ; 163(2): 26, 2021 02.
Artigo em Alemão | MEDLINE | ID: mdl-33527277

Assuntos
Glaucoma , Melanoma , Humanos
8.
Vestn Oftalmol ; 137(1): 54-59, 2021.
Artigo em Russo | MEDLINE | ID: mdl-33610150

RESUMO

PURPOSE: To study the frequency and nature of intraoperative and early postoperative complications after glaucoma surgeries depending on several factors. MATERIAL AND METHODS: The study retrospectively analyzed 87 outpatient records and case histories of patients with primary open-angle glaucoma (POAG). All subjects had undergone standard trabeculectomy. The indication for surgical treatment was deterioration of visual function associated with increased intraocular pressure (IOP). During the follow-up, an assessment was made of intraoperative and early postoperative complications, as well as factors leading to their development. RESULTS: During the observation period, the most frequently developing complications were found to be ciliochoroidal detachment - in 22 (25.8%) patients, and hyphema - in 12 (13.8%). One of the reasons for these complications is a significant, sometimes critical change in intraocular pressure when cutting open the eye. Isolated intraocular hypotension without signs of ciliochoroidal detachment was detected in 15 (17.24%) patients. Postoperative hypertension was found in 18 (20.68%) patients. Scarring of the newly created outflow tracts of intraocular fluid was the obvious cause of ophthalmic hypertension in 5 patients. In 16 (18.4%) cases, pronounced vascularization was found at the site of surgical intervention. CONCLUSION: The most significant factors that have a possible impact on the outcome of glaucoma surgery - specifically, its hypotensive effect - are: age, duration of local antihypertensive therapy, comorbid somatic pathology, and the initial IOP level.


Assuntos
Glaucoma , Trabeculectomia , Seguimentos , Glaucoma/cirurgia , Humanos , Pressão Intraocular , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Resultado do Tratamento
9.
Klin Monbl Augenheilkd ; 238(2): 146-152, 2021 Feb.
Artigo em Inglês, Alemão | MEDLINE | ID: mdl-33543764

RESUMO

Glaucoma patients often bear a long-lasting burden of disease. This can result in anxiety and stress. Causes and effects of anxiety are identified and case studies illustrate how to deal with them. Some knowledge of psychosomatic management is helpful for doctors in dealing with their patients to provide necessary treatment in a less fearful and stressful format.


Assuntos
Glaucoma , Médicos , Seguimentos , Glaucoma/cirurgia , Humanos , Transtornos Psicofisiológicos/diagnóstico
10.
Klin Monbl Augenheilkd ; 238(2): 132-145, 2021 Feb.
Artigo em Inglês, Alemão | MEDLINE | ID: mdl-33578436

RESUMO

The prognosis of going blind is very stressful for patients diagnosed with "glaucoma". Worries and fear of losing independence is a constant mental burden, with secondary risks of depression and social isolation. But stress is not only a result of glaucoma but also a possible cause (risk factor). This should not be surprising, given that chronic stress can trigger "psychosomatic" organ dysfunctions anywhere in the body. Why should the organ "eye" be an exception? Indeed, glaucoma patients often suspect that severe emotional stress caused their visual field loss or "foggy vision". The hypothesis that stress is a possible cause of glaucoma is supported by different observations: (i) acute and chronic stress increases intraocular pressure and (ii) long-term stress can lead to vascular dysregulation of the microcirculation in the eye and brain ("Flammer's syndrome"), leading to partial hypoxia and hypoglycaemia (hypo-metabolism). Even if nerve cells do not die, they may then become inactive ("silent" neurons). (iii) Degenerative changes have been reported in the brain of glaucoma patients, affecting not only anterograde or transsynaptic areas of the central visual pathway, but degeneration is also found (iv) in brain areas involved in emotional appraisal and the physiological regulation of stress hormones. There are also psychological hints indicating that stress is a cause of glaucoma: (v) Glaucoma patients with Flammer's syndrome show typical personality traits that are associated with low stress resilience: they often have cold hands or feet, are ambitious (professionally successful), perfectionistic, obsessive, brooding and worrying a lot. (vi) If stress hormone levels and inflammation parameters are reduced in glaucoma patients by relaxation with meditation, this correlates with normalisation of intraocular pressure, and yet another clue is that (vii) visual field improvements after non-invasive current stimulation therapy, that are known to improve circulation and neuronal synchronisation, are much most effective in patients with stress resilient personalities. An appreciation of stress as a "cause" of glaucoma suggests that in addition to standard therapy (i) stress reduction through relaxation techniques should be recommended (e.g. meditation), and (ii) self-medication compliance should not be induced by kindling anxiety and worries with negative communication ("You will go blind!"), but communication should be positive ("The prognosis is optimistic").


Assuntos
Glaucoma , Humanos , Pressão Intraocular , Tonometria Ocular , Testes de Campo Visual , Vias Visuais
11.
Klin Monbl Augenheilkd ; 238(2): 153-160, 2021 Feb.
Artigo em Inglês, Alemão | MEDLINE | ID: mdl-33618389

RESUMO

Glaucoma poses the second largest cause of severe visual impairment and loss of vision worldwide. Despite the progress in both pharmaceutical and surgical treatments, the attempts to decrease intraocular pressure and prevent progression of glaucomatous optic neuropathy fail in many cases. Hence there is a high demand for additional complementary methods, which can reduce intraocular pressure and improve ocular blood flow as well as mental well-being. On the basis of literature research, the study results published so far on the effectiveness of psychotherapeutical methods in glaucoma therapy will be presented here. The methods of autogenic training, hypnosis and music therapy have already been demonstrated to have a positive effect on intraocular pressure, ocular blood flow and psychological well-being of patients affected by glaucoma. With these methods being not only effective but also cost-efficient, free of side effects and easily administered, they could gain importance in terms of an adjuvant treatment option for patients with glaucoma. However, regular ophthalmological examinations still remain obligatory.


Assuntos
Glaucoma , Doenças do Nervo Óptico , Glaucoma/terapia , Humanos , Pressão Intraocular , Nervo Óptico , Transtornos da Visão
12.
Cochrane Database Syst Rev ; 2: CD012707, 2021 Feb 26.
Artigo em Inglês | MEDLINE | ID: mdl-33634854

RESUMO

BACKGROUND: To support patient-centred care, healthcare organisations increasingly offer patients access to data stored in the institutional electronic health record (EHR). OBJECTIVES: Primary objective 1. To assess the effects of providing adult patients with access to electronic health records (EHRs) alone or with additional functionalities on a range of patient, patient-provider, and health resource consumption outcomes, including patient knowledge and understanding, patient empowerment, patient adherence, patient satisfaction with care, adverse events, health-related quality of life, health-related outcomes, psychosocial health outcomes, health resource consumption, and patient-provider communication. Secondary objective 1. To assess whether effects of providing adult patients with EHR access alone versus EHR access with additional functionalities differ among patient groups according to age, educational level, or different status of disease (chronic or acute). SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase, PsycINFO, CINAHL, and Scopus in June 2017 and in April 2020. SELECTION CRITERIA: Randomised controlled trials and cluster-randomised trials of EHR access with or without additional functionalities for adults with any medical condition. DATA COLLECTION AND ANALYSIS: We used standard Cochrane methodological procedures. MAIN RESULTS: We included 10 studies with 78 to 4500 participants and follow-up from 3 to 24 months. Nine studies assessed the effects of EHR with additional functionalities, each addressing a subset of outcomes sought by this review. Five studies focused on patients with diabetes mellitus, four on patients with specific diseases, and one on all patients. All studies compared EHR access alone or with additional functionalities plus usual care versus usual care only. No studies assessing the effects of EHR access alone versus EHR access with additional functionalities were identified. Interventions required a variety of data within the EHR, such as patient history, problem list, medication, allergies, and lab results. In addition to EHR access, eight studies allowed patients to share self-documented data, seven offered individualised disease management functions, seven offered educational disease-related information, six supported secure communication, and one offered preventive reminders. Only two studies were at low or unclear risk of bias across domains. Meta-analysis could not be performed, as participants, interventions, and outcomes were too heterogeneous, and most studies presented results based on different adjustment methods or variables. The quality of evidence was rated as low or very low across outcomes. Overall differences between intervention and control groups, if any, were small. The relevance of any small effects remains unclear for most outcomes because in most cases, trial authors did not define a minimal clinically important difference. Overall, results suggest that the effects of EHR access alone and with additional functionalities are mostly uncertain when compared with usual care. Patient knowledge and understanding: very low-quality evidence is available from one study, so we are uncertain about effects of the intervention on patient knowledge about diabetes and blood glucose testing. Patient empowerment: low-quality evidence from three studies suggests that the intervention may have little or no effect on patient empowerment measures. Patient adherence: low-quality evidence from two studies suggests that the intervention may slightly improve adherence to the process of monitoring risk factors and preventive services. Effects on medication adherence are conflicting in two studies; this may or may not improve to a clinically relevant degree. Patient satisfaction with care: low-quality evidence from three studies suggests that the intervention may have little or no effect on patient satisfaction, with conflicting results. Adverse events: two small studies reported on mortality; one of these also reported on serious and other adverse events, but sample sizes were too small for small differences to be detected. Therefore, low-quality evidence suggests that the intervention may have little to no effect on mortality and other adverse events. Health-related quality of life: only very low-quality evidence from one study is available. We are uncertain whether the intervention improves disease-specific quality of life of patients with asthma. Health-related outcomes: low-quality evidence from eight studies suggests that the intervention may have little to no effect on asthma control, glycosylated haemoglobin (HbA1c) levels, blood pressure, low-density lipoprotein or total cholesterol levels, body mass index or weight, or 10-year Framingham risk scores. Low-quality evidence from one study suggests that the composite scores of risk factors for diabetes mellitus may improve slightly with the intervention, but there is uncertainty about effects on ophthalmic medications or intraocular pressure. Psychosocial health outcomes: no study investigated psychosocial health outcomes in a more than anecdotal way. Health resource consumption: low-quality evidence for adult patients in three studies suggests that there may be little to no effect of the intervention on different measures of healthcare use. Patient-provider communication: very low-quality evidence is available from a single small study, and we are uncertain whether the intervention improves communication measures, such as the number of messages sent. AUTHORS' CONCLUSIONS: The effects of EHR access with additional functionalities in comparison with usual care for the most part are uncertain. Only adherence to the process of monitoring risk factors and providing preventive services as well as a composite score of risk factors for diabetes mellitus may improve slightly with EHR access with additional functionalities. Due to inconsistent terminology in this area, our search may have missed relevant studies. As the overall quality of evidence is very low to low, future research is likely to change these results. Further trials should investigate the impact of EHR access in a broader range of countries and clinical settings, including more patients over a longer period of follow-up, as this may increase the likelihood of detecting effects of the intervention, should these exist. More studies should focus on assessing outcomes such as patient empowerment and behavioural outcomes, rather than concentrating on health-related outcomes alone. Future studies should distinguish between effects of EHR access only and effects of additional functionalities, and investigate the impact of mobile EHR tools. Future studies should include information on usage patterns, and consider the potential for widening health inequalities with implementation of EHR access. A taxonomy for EHR access and additional functionalities should be developed to promote consistency and comparability of outcome measures, and facilitate future reviews by better enabling cross-study comparisons.


Assuntos
Registros Eletrônicos de Saúde , Acesso dos Pacientes aos Registros , Adulto , Asma/terapia , Viés , Glicemia/análise , Compreensão , Diabetes Mellitus/sangue , Diabetes Mellitus/diagnóstico , Registros Eletrônicos de Saúde/estatística & dados numéricos , Glaucoma/tratamento farmacológico , Conhecimentos, Atitudes e Prática em Saúde , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Insuficiência Cardíaca/terapia , Humanos , Hipertensão/terapia , Pessoa de Meia-Idade , Acesso dos Pacientes aos Registros/estatística & dados numéricos , Cooperação do Paciente , Participação do Paciente , Satisfação do Paciente , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
14.
Sensors (Basel) ; 21(2)2021 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-33467457

RESUMO

Glaucoma causes total or partial loss of vision in 10% of people over the age of 70, increasing their fragility and isolation. It is characterised by the destruction of the optic nerve fibres, which may result from excessively high intraocular pressure as well as other phenomena. Diagnosis is currently reached through a combination of several checks, mainly of the eyes' fundus, tonometry and gonioscopy. Prior to validation for human subjects, the objective of this study is to validate whether ocular phantom-based models could be used to diagnose glaucoma using an onboard system, which could, even at home, prevent the early-stage development of the pathology. Eight phantoms modelling healthy eyes and eight phantoms modelling eyes with glaucoma due to excessive intraocular pressure were measured using an onboard system, including lens and electrophysiology electronics. We measured the actual average Zr (real part of impedance) impedance of 160.9 ± 24.3 ohms (glaucoma ocular phantom models) versus 211.9 ± 36.9 ohms (healthy ocular phantom models), and an average total water volume (Vt) of 3.02 ± 0.35 mL (glaucoma ocular phantom models) versus 2.45 ± 0.28 mL (healthy ocular Phantoms). On average, we obtained 51 ohms (-24.1%) less and 0.57 mL (22.9%) of total water volume more, respectively. Normality tests (Shapiro-Wilk) for Vt and Zr indicate p < 0.001 and p < 0.01, respectively. Since these variables do not respect normal laws, unmatched Mann-Whitney tests were performed indicating a significant difference between Vt and Zr in the healthy ocular phantom models and those modelling glaucoma. To conclude, this preliminary study indicates the possibility of discriminating between healthy eyes with those with glaucoma. However, further large-scale studies involving healthy eyes and those suffering from glaucoma are necessary to generate viable models.


Assuntos
Glaucoma , Hipertensão Ocular , Diagnóstico Precoce , Estudos de Viabilidade , Glaucoma/diagnóstico , Humanos , Modelos Teóricos , Tonometria Ocular
15.
Curr Opin Ophthalmol ; 32(2): 134-140, 2021 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-33492867

RESUMO

PURPOSE OF REVIEW: Glaucoma patients commonly suffer from ocular surface disease (OSD). As treatment strategies, medications and devices for the treatment of OSD as well as glaucoma surgical approaches evolve rapidly, it is important to consider their application to these patients. RECENT FINDINGS: OSD in glaucoma patients may lead to reduced reliability of diagnostic tests, decreased medication compliance, poor surgical outcomes, and overall decreased quality of life. Chronic use of topical glaucoma medications has been linked to the development of limbal stem cell deficiency, and the role of preservatives in OSD continues to be demonstrated. Preservative free glaucoma medications as well as new anti-inflammatory agents for the treatment of OSD are now available. Omega-3 fatty acid supplementation and punctal plugs have been shown to benefit glaucoma patients with OSD. Drop burden may be reduced through the use of the new sustained-release delivery systems, selective laser trabeculoplasty, and minimally invasive glaucoma surgery. SUMMARY: There are multiple emerging strategies for managing OSD that may be applied to patients with glaucoma. With continued research and clinical experiences, we hope to better understand the multifaceted relationship between glaucoma and OSD and develop evidence-based algorithms for the management of these complex patients.


Assuntos
Doenças da Túnica Conjuntiva/terapia , Doenças da Córnea/terapia , Síndromes do Olho Seco/terapia , Doenças Palpebrais/terapia , Glaucoma/complicações , Doenças do Aparelho Lacrimal/terapia , Anti-Inflamatórios/uso terapêutico , Anti-Hipertensivos/uso terapêutico , Glaucoma/tratamento farmacológico , Humanos , Pressão Intraocular/fisiologia , Conservantes Farmacêuticos/uso terapêutico , Qualidade de Vida
16.
Yakugaku Zasshi ; 141(1): 61-66, 2021.
Artigo em Japonês | MEDLINE | ID: mdl-33390449

RESUMO

Glaucoma, the leading cause of blindness in adults, is a progressive neurodegenerative disease characterized by retinal ganglion cell (RGC) death. Currently, many intraocular pressure (IOP)-lowering drugs known to affect this disease progression have been developed as therapeutic agents. However, there are many cases of disease progression, even with sufficient IOP reduction. Therefore, newer therapeutic approaches other than IOP-lowering drugs are needed. To elucidate the pathogenesis of glaucoma and to develop therapeutic agents, the evaluation of RGCs is imperative, as their degeneration is the main cause of this disease. However, it is difficult to obtain RGCs from healthy individuals, let alone glaucoma patients. Therefore, research on the pathophysiology of glaucoma and drug discovery has not progressed sufficiently. Recent developments have made it possible to generate induced pluripotent stem (iPS) cells from the blood or skin of glaucoma patients and induce them to differentiate into RGCs to study the pathogenesis of glaucoma. In addition, drug repositioning for ophthalmological diseases such as glaucoma is one of the most active fields. Many of these repositioned drugs have found therapeutic applications in ophthalmology. Here, we introduce the current status of the pharmacological treatment of glaucoma and its prospects.


Assuntos
Descoberta de Drogas/tendências , Reposicionamento de Medicamentos/tendências , Glaucoma/terapia , Diferenciação Celular , Progressão da Doença , Glaucoma/etiologia , Glaucoma/patologia , Humanos , Células-Tronco Pluripotentes Induzidas/citologia , Pressão Intraocular , Células Ganglionares da Retina/patologia
17.
Medicine (Baltimore) ; 100(2): e24069, 2021 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-33466164

RESUMO

ABSTRACT: To investigate the impact of different types of binocular integrated visual field defects on the quality of life in glaucoma.Ninety-six patients with primary glaucoma were divided into 5 groups with 25, 24, 11, 15, and 21 patients according to types of the binocular integrated visual field (BVF) defects. The criteria for BVF grouping included mild visual field defect in binocular eyes, mild visual field defect in 1 eye and moderate or advanced defect in the other, moderate and non-overlapping visual field defect in both eyes, overlapping and moderate visual field defect in binocular eyes, and severe defect in both eyes, respectively. The visual field (VF) evaluation was based on H-P-A visual field grading system. Visual acuity, visual field tests and Glaucoma Quality of Life-15 Questionnaire (GQL-15) were performed for enrolled patients, and binocular visual field results were integrated. The changes and correlations of the Visual field index values and quality of life scores were compared among the 5 groups. The main factors affecting the quality of life in glaucoma were analyzed by multiple regression analysis.The best binocular integrated visual field index (BVFI) and optimal quality of life were observed in group A. The BVFI of group B was better than that of group C or group D, but the peripheral vision glare and dark adaptation were worse. No significant difference was noted between group C and group D in terms of BVFI. However, the glare and dark adaptation in group C were better than that in group D. The BVFI was the lowest and the quality of life was the worst in group E. In all, BVFI and decibels (dB) values were negatively correlated with GQL-15 scores and positively correlated with patients' quality of life.Binocular integrated visual field accurately reflects the visual function in glaucoma. Higher binocular integrated visual field indices represent a better quality of life for patients with glaucoma. Mild to moderate synchronous or complementary binocular VF defects had a slight effect on the quality of life, while severe and non-compensated VF loss significantly impacts on quality of life in glaucoma patients.


Assuntos
Glaucoma/fisiopatologia , Qualidade de Vida/psicologia , Perfil de Impacto da Doença , Transtornos da Visão/psicologia , Visão Binocular , Idoso , Feminino , Glaucoma/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Transtornos da Visão/etiologia , Acuidade Visual , Testes de Campo Visual , Campos Visuais
18.
JAMA ; 325(2): 177-178, 2021 01 12.
Artigo em Inglês | MEDLINE | ID: mdl-33433573
19.
Medicina (Kaunas) ; 57(1)2021 Jan 07.
Artigo em Inglês | MEDLINE | ID: mdl-33430228

RESUMO

Background and objectives: primary congenital glaucoma (PCG) is a rare, potentially blinding disease that affects children worldwide. The aim of the study was to describe the epidemiological and clinical characteristics, outcomes for newly diagnosed patients with PCG, as well as evaluate the prognostic factors that are related to the outcomes. Materials and Methods: a retrospective cohort study was conducted at a tertiary referral centre among patients diagnosed with PCG. Evaluation of the clinical data was performed preoperatively at three, six, and 12 months after the surgery and at the last follow-up. Results: during the 15 years of follow-ups, 24 eyes of 18 patients were diagnosed with PCG. Unilateral and bilateral PCG constituted 50% of cases each. A slight male predominance was observed (55.6% vs. 44.4%), with a relative risk of 1.3. The incidence of PCG was 1:19,033 live births. The mean age of the patients at the time of diagnosis was 10.1 ± 10.0 months, with a diagnostic delay of 2.0 ± 1.9 months. Furthermore, 75% of patients indicated an enlargement of an eyeball, followed by excessive tearing (58.3%) and corneal opacity (41.7%). After 85.9 ± 51.2 months, the mean intraocular pressure (IOP) value was 14.6 ± 4.9 mmHg. Surgical treatment provided sufficient IOP control in 75% of PCG cases at the last follow-up visit. The only prognostic factor that was related to the outcome of IOP control that was statistically significant was axial length at the time of diagnosis. Conclusions: the incidence of PCG in Latvia was 5.3 patients per 100,000 live births. PCG was more common among males than females with a relative risk of 1.3. The enlargement of an eyeball was the leading clinical sign.


Assuntos
Comprimento Axial do Olho/fisiopatologia , Glaucoma/congênito , Trabeculectomia , Administração Oftálmica , Ambliopia/fisiopatologia , Astigmatismo/fisiopatologia , Estudos de Coortes , Diagnóstico Tardio , Feminino , Glaucoma/epidemiologia , Glaucoma/fisiopatologia , Glaucoma/terapia , Humanos , Lactente , Recém-Nascido , Pressão Intraocular/fisiologia , Letônia/epidemiologia , Masculino , Prognóstico , Sistema de Registros , Estudos Retrospectivos , Distribuição por Sexo , Resultado do Tratamento , Acuidade Visual
20.
Curr Opin Ophthalmol ; 32(2): 129-133, 2021 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-33395110

RESUMO

PURPOSE OF REVIEW: To discuss a new class of medication that has recently become available for the treatment of glaucoma; as well as share insights into developments in glaucoma medicine administration which has the potential to revolutionize medical therapy for glaucoma. RECENT FINDINGS: Newly available eye drops, netarsudil 0.02% and latanoprostene bunod 0.024%, are improving aqueous outflow through the conventional outflow tract. Other new developments in medical glaucoma are focused on alternative methods for sustained glaucoma medication delivery. SUMMARY: Newer medications may be able to extend the duration of medically controlled glaucoma, delaying or possibly eliminating the need of glaucoma surgery for some patients. Alternative methods of delivery for glaucoma medications may be a key factor in improving outcomes with currently available medications.


Assuntos
Anti-Hipertensivos/uso terapêutico , Benzoatos/uso terapêutico , Glaucoma/tratamento farmacológico , Pressão Intraocular/efeitos dos fármacos , Prostaglandinas F Sintéticas/uso terapêutico , beta-Alanina/análogos & derivados , Administração Oftálmica , Humanos , Soluções Oftálmicas , beta-Alanina/uso terapêutico , Quinases Associadas a rho/antagonistas & inibidores
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