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2.
Indian J Ophthalmol ; 70(5): 1502-1512, 2022 05.
Artigo em Inglês | MEDLINE | ID: mdl-35502015

RESUMO

The objective of this meta-analysis was to evaluate the effect of prostaglandin analogues (PGA) on central corneal thickness (CCT) in patients with glaucoma. Key electronic databases were searched for randomized controlled trials (RCTs) involving the CCT effects of prostaglandin use for glaucoma. Primary outcome measures were the mean difference in the CCT measurement from baseline to the last available assessment. Intraocular pressure and other corneal changes were recorded as secondary. Efficacy estimates were measured by their weighted mean difference (WMD) with 95% confidence intervals (CI's) by using the random-effects model for primary and secondary outcomes Trial sequential analysis was used to determine if the current evidence was sufficient and conclusive. Eight RCTs met our inclusion criteria. A total of 879 patients were included. The overall effect showed that PGA's had a significant CCT lowering effect (WMD = -7.04, 95%CI: -10.07 to -4.00, P < 0.00001). We pooled results of 5 RCT's on Travoprost (WMD = -10.44, 95%CI: -16.80 to -4.08, P = 0.001), seven trials on Latanoprost (WMD = -4.73, 95% CI: -9.70 to 0.25, P = 0.06), and three trials on Bimatoprost (WMD = -11.88, 95%CI: -21.03 to -2.73, P = 0.01). The WMD across groups in >6 months of PGA use was -11.37 (95%CI: -17.17 to -5.58, P = 0.0001), and in <6 months of PGAs group was -8.35 (95% CI: -12.01 to -4.69, P < 0.00001), suggesting a longitudinal effect of PGAs on CCT. In conclusion, Bimatoprost and Travoprost caused a statistically significant reduction in the thickness of central cornea. Though only a few studies were included, the narrow confidence intervals and adequate sample size suggest that these findings are valid.


Assuntos
Glaucoma de Ângulo Aberto , Glaucoma , Prostaglandinas F Sintéticas , Amidas , Anti-Hipertensivos/uso terapêutico , Bimatoprost , Cloprostenol/efeitos adversos , Glaucoma/induzido quimicamente , Glaucoma/tratamento farmacológico , Glaucoma de Ângulo Aberto/tratamento farmacológico , Humanos , Prostaglandinas A , Prostaglandinas F Sintéticas/efeitos adversos , Prostaglandinas Sintéticas/uso terapêutico , Travoprost
3.
Indian J Ophthalmol ; 70(5): 1626-1633, 2022 05.
Artigo em Inglês | MEDLINE | ID: mdl-35502039

RESUMO

Purpose: : To analyze the ocular surface changes in eyes after the withdrawal of anti-glaucomatous drugs when non-penetrating deep sclerectomy (NPDS) is performed. Methods: Thirty-one patients (33 eyes) diagnosed with glaucoma that underwent NPDS were included in this prospective study. The control group included 33 eyes. Four variables were studied using Keratograph 5M (K5M): ocular hyperemia (OH), non-invasive tear film break-up time (NI-BUT), lower tear meniscus height (LTMH), and meibography. LTMH was also measured using the anterior segment module of a Spectralis Fourier-domain optical coherence tomography (FD-OCT) instrument. Moreover, an evaluation of corneal and conjunctival staining was performed. In the glaucoma group, five visits were carried out: pre-surgery, 1 week after surgery, and 1 month, 3 months, and 6 months after surgery. In control groups, examinations were performed in only one visit. In addition, patients were asked to answer two questionnaires: Ocular Surface Disease Index (OSDI) and National Eye Institute Visual Functioning Questionnaire (NEI VFQ-25) before and 6 months after surgery. Results: Before NPDS, eyes showed worse objective data than healthy control subjects (P ≤ 0.049). In this group, a significant improvement was observed in questionnaire responses (P < 0.001), LTMH-FD-OCT (P = 0.037), LTMH-K5M (P = 0.025), K5M-OH (P = 0.003), NI-BUT (P = 0.022), and conjunctival and corneal staining (P < 0.001). No significant differences were observed between groups in FD-OCT and K5M LTMH, NI-BUT, corneal-conjunctival staining, nor in the most OH sector values at 6 months (P ≥ 0.62). Conclusion: A significant improvement in the ocular surface was observed 6 months after NPDS, suggesting that the withdrawal of the topical anti-glaucomatous treatment had a beneficial effect on the subjects.


Assuntos
Doenças da Túnica Conjuntiva , Síndromes do Olho Seco , Glaucoma , Córnea , Síndromes do Olho Seco/diagnóstico , Glaucoma/tratamento farmacológico , Humanos , Estudos Prospectivos
5.
Indian J Ophthalmol ; 70(5): 1812-1814, 2022 05.
Artigo em Inglês | MEDLINE | ID: mdl-35502080

RESUMO

The presence of emulsified silicone oil in the eye can lead to many complications, glaucoma being one of the most common. Adequate IOP control is difficult to achieve with medical management alone; surgical intervention is often required. Glaucoma drainage device implantation is often the preferred line of surgical intervention in such cases due to trabeculectomy failure from emulsified silicone oil droplets and associated conjunctival scarring. However, the silicone tube of Ahmed glaucoma valve (AGV) may attract the silicone oil droplets, causing blockade of the tube with persistent raised IOP postoperatively. We report one such case where post-AGV silicone oil tube occlusion was treated with semi-conservative surgical management instead of revising the entire surgery or implantation of another drainage device. Our surgical technique of intracameral "vent and flush" offers rapid and effective IOP control in such cases. Postoperatively, normal IOP was achieved. Patency of tube continued to be maintained along with normalization of IOP on subsequent follow-ups.


Assuntos
Implantes para Drenagem de Glaucoma , Glaucoma , Glaucoma/cirurgia , Humanos , Pressão Intraocular , Estudos Retrospectivos , Óleos de Silicone
9.
Indian J Ophthalmol ; 70(5): 1868-1869, 2022 05.
Artigo em Inglês | MEDLINE | ID: mdl-35502116

RESUMO

Background: Artificial Intelligence (AI) is an area of computer science that encompasses the creation of intelligent machines that work and react like humans. It deals with the development algorithms that seek to simulate human brain and also mimic cognitive functions typically associated with the human mind such as learning and problem solving. Purpose: Do we need artificial intelligence in Glaucoma? Glaucoma is the second most common cause of blindness in the world. Its prevalence was over 60 million in 2010 and over 80 million by 2020. It is so common, yet so easily overlooked. More importantly, about 50% of patients in developed countries and 90% in developing countries are unaware of having glaucoma. Early detection can delay the progression of glaucoma. Hence the time is ripe to advovate glaucoma screening. Synopsis: The application of AI in ophthalmology mainly concentrates on the diseases with a high incidence, such as diabetic retinopathy, age-related macular degeneration, glaucoma, retinopathy of prematurity, age-related or congenital cataract etc AI involves mainly 1. machine learning that are algorithms with the ability to learn without being explicitly programmed and 2. deep learning in which artificial neural networks adapt and learn from vast amounts of data. But there are limitations to screening - such as disparity between ophthalmologist:patient ratio and also the availability of the specialty services. The large amount of data acquired from patients makes it nearly impossible for ophthalmologists to screen them with equal efficacy and consistency. Highlights: AI in glaucoma aims at including factors such as clinical data, genomic data, life style behaviors, risk factors, and medical history to predict the risk of developing glaucoma, help customise the most appropriate management protocol for a given patient, and estimate prognosis and surgical success. Video Link: https://youtu.be/IwYS7wDMhkY.


Assuntos
Glaucoma , Oftalmologia , Algoritmos , Inteligência Artificial , Técnicas de Diagnóstico Oftalmológico , Glaucoma/diagnóstico , Humanos , Recém-Nascido , Oftalmologia/métodos
10.
Transl Vis Sci Technol ; 11(5): 5, 2022 May 02.
Artigo em Inglês | MEDLINE | ID: mdl-35522306

RESUMO

Purpose: Data postprocessing with statistical techniques that are less sensitive to noise can be used to reduce variability in visual field (VF) series. We evaluated the detection of glaucoma progression with postprocessed VF data generated with the dynamic structure-function (DSF) model and MM-estimation robust regression (MRR). Method: The study included 118 glaucoma eyes with at least 15 visits selected from the Rotterdam dataset. The DSF and MRR models were each applied to observed mean deviation (MD) values from the first three visits (V1-3) to predict the MD at V4. MD at V5 was predicted with data from V1-4 and so on until the MD at V9 was predicted, creating two additional datasets: DSF-predicted and MRR-predicted. Simple linear regression was performed to assess progression at the ninth visit. Sensitivity was evaluated by adjusting for false-positive rates estimated from patients with stable glaucoma and by using longer follow-up series (12th and 15th visits) as a surrogate for progression. Results: For specificities of 80% to 100%, the DSF-predicted dataset had greater sensitivity than the observed and MRR-predicted dataset when positive rates were normalized with corresponding false-positive estimates. The DSF-predicted and observed datasets had similar sensitivity when the surrogate reference standard was applied. Conclusions: Without compromising specificity, the use of DSF-predicted measurements to identify progression resulted in a better or similar sensitivity compared to using existing VF data. Translational Relevance: The DSF model could be applied to postprocess existing visual field data, which could then be evaluated to identify patients at risk of progression.


Assuntos
Glaucoma , Campos Visuais , Progressão da Doença , Glaucoma/diagnóstico , Humanos , Modelos Lineares , Testes de Campo Visual
13.
Invest Ophthalmol Vis Sci ; 63(5): 2, 2022 05 02.
Artigo em Inglês | MEDLINE | ID: mdl-35503230

RESUMO

Purpose: To assess the changes in retinal morphology in a rat model of chronic glaucoma induced by ocular hypertension. Methods: Intraocular pressure (IOP) was surgically increased through weekly injections of sodium hyaluronate (HYA) in the anterior eye chamber of the left eye of male Wistar rats, whereas the right eyes were sham operated (salt solution). During the 10-week experimental period, IOP was measured weekly with a rebound tonometer. Retinal cryosections were prepared for histological/immunohistochemical analysis and morphometry. Results: IOP was higher in HYA-treated eyes than in sham-operated eyes along the 10-week period, which was significant from the fourth to the nineth week. Ocular hypertension in HYA-treated eyes was associated with morphologic and morphometric changes in bipolar cells, ON-OFF direction-selective ganglion cells, ON/OFF starburst amacrine cells, and inner plexiform layer sublamina. Conclusions: Serial HYA treatment in the rat anterior eye chamber results in mild-to-moderate elevated and sustained IOP and ganglion cell death, which mimics most human open-angle glaucoma hallmarks. The reduced number of direction-selective ganglion cells and starburst amacrine cells accompanied by a deteriorated ON/OFF plexus in this glaucoma model could lend insight to the abnormalities in motion perception observed in patients with glaucoma.


Assuntos
Glaucoma de Ângulo Aberto , Glaucoma , Hipertensão Ocular , Animais , Modelos Animais de Doenças , Glaucoma de Ângulo Aberto/metabolismo , Humanos , Ácido Hialurônico/metabolismo , Pressão Intraocular , Masculino , Ratos , Ratos Wistar , Células Ganglionares da Retina/metabolismo
14.
Transl Vis Sci Technol ; 11(5): 7, 2022 May 02.
Artigo em Inglês | MEDLINE | ID: mdl-35536721

RESUMO

Purpose: Scleral stiffening may protect against glaucomatous retinal ganglion cell (RGC) loss or dysfunction associated with ocular hypertension. Here, we assess the potential neuroprotective effects of two treatments designed to stiffen either the entire posterior sclera or only the sclera adjacent to the peripapillary sclera in an experimental model of glaucoma. Methods: Rat sclerae were stiffened in vivo using either genipin (crosslinking the entire posterior sclera) or a regionally selective photosensitizer, methylene blue (stiffening only the juxtaperipapillary region surrounding the optic nerve). Ocular hypertension was induced using magnetic microbeads delivered to the anterior chamber. Morphological and functional outcomes, including optic nerve axon count and appearance, retinal thickness measured by optical coherence tomography, optomotor response, and electroretinography traces, were assessed. Results: Both local (juxtaperipapillary) and global (whole posterior) scleral stiffening treatments were successful at increasing scleral stiffness, but neither provided demonstrable neuroprotection in hypertensive eyes as assessed by RGC axon counts and appearance, optomotor response, or electroretinography. There was a weak indication that scleral crosslinking protected against retinal thinning as assessed by optical coherence tomography. Conclusions: Scleral stiffening was not demonstrated to be neuroprotective in ocular hypertensive rats. We hypothesize that the absence of benefit may in part be due to RGC loss associated with the scleral stiffening agents themselves (mild in the case of genipin, and moderate in the case of methylene blue), negating any potential benefit of scleral stiffening. Translational Relevance: The development of scleral stiffening as a neuroprotective treatment will require the identification of better tolerated stiffening protocols and further preclinical testing.


Assuntos
Glaucoma , Esclera , Animais , Pressão Intraocular , Azul de Metileno/farmacologia , Azul de Metileno/uso terapêutico , Neuroproteção , Ratos
15.
Zhonghua Yan Ke Za Zhi ; 58(5): 321-325, 2022 May 11.
Artigo em Chinês | MEDLINE | ID: mdl-35511657

RESUMO

Glaucoma following cataract surgery is one of the common complications after pediatric cataract surgery, and it is the main cause of "second blindness" in children. Since this atypical disease is difficult to diagnose and evaluate, it has been gradually paid more attention by clinicians. There are still some controversies and challenges related to the characteristics of the disease, diagnostic criteria, and treatment options. This article discusses the definition, diagnostic criteria, related risk factors, treatment strategies, follow-up, and prognoses of glaucoma following cataract surgery. Establishment of a diagnosis and treatment system can better improve the visual rehabilitation of pediatric cataract children.


Assuntos
Extração de Catarata , Catarata , Glaucoma , Baixa Visão , Cegueira/etiologia , Catarata/complicações , Catarata/terapia , Extração de Catarata/efeitos adversos , Criança , Seguimentos , Glaucoma/diagnóstico , Humanos , Estudos Retrospectivos , Baixa Visão/etiologia
16.
Zhonghua Yan Ke Za Zhi ; 58(5): 373-375, 2022 May 11.
Artigo em Chinês | MEDLINE | ID: mdl-35511664

RESUMO

An eleven-year-old boy visited the Department of Ophthalmology due to visual acuity loss accompanied by high intraocular tension in the left eye for one year. Besides glaucoma, the typical ocular manifestations of neurofibromatosis type 1 such as bilateral Lisch nodules of the iris, multiple patchy choroidal nodules and retinal microvascular abnormalities were identified, and Cafe-au-lait macules appeared on the body skin. Based on the medical history, clinical presentation and auxiliary examination results, the diagnosis of neurofibromatosis type 1 with secondary glaucoma in the left eye was confirmed.


Assuntos
Glaucoma , Hamartoma , Neurofibromatose 1 , Manchas Café com Leite/complicações , Manchas Café com Leite/diagnóstico , Criança , Corioide , Glaucoma/complicações , Humanos , Masculino , Neurofibromatose 1/complicações , Neurofibromatose 1/diagnóstico
17.
Int J Mol Sci ; 23(8)2022 Apr 07.
Artigo em Inglês | MEDLINE | ID: mdl-35456925

RESUMO

Neuroinflammation is a crucial process for the loss of retinal ganglion cells (RGC), a major characteristic of glaucoma. High expression of high-mobility group box protein 1 (HMGB1) plays a detrimental role in inflammatory processes and is elevated in the retinas of glaucoma patients. Therefore, this study aimed to investigate the effects of the intravitreal injection of an anti-HMGB1 monoclonal antibody (anti-HMGB1 Ab) in an experimental animal model of glaucoma. Two groups of Spraque Dawley rats received episcleral vein occlusion to chronically elevate intraocular pressure (IOP): (1) the IgG group, intravitreal injection of an unspecific IgG as a control, n = 5, and (2) the HMGB1 group, intravitreal injection of an anti-HMGB1 Ab, n = 6. IOP, retinal nerve fiber layer thickness (RNFLT), and the retinal flash response were monitored longitudinally. Post-mortem examinations included immunohistochemistry, microarray, and mass spectrometric analysis. RNFLT was significantly increased in the HMGB1 group compared with the IgG group (p < 0.001). RGC density showed improved neuronal cell survival in the retina in HMGB1 compared with the IgG group (p < 0.01). Mass spectrometric proteomic analysis of retinal tissue showed an increased abundance of RNA metabolism-associated heterogeneous nuclear ribonucleoproteins (hnRNPs), such as hnRNP U, D, and H2, in animals injected with the anti-HMGB1 Ab, indicating that the application of the antibody may cause increased gene expression. Microarray analysis showed a significantly decreased expression of C-X-C motif chemokine ligand 8 (CXCL8, p < 0.05) and connective tissue growth factor (CTGF, p < 0.01) in the HMGB1 group. Thus, these data suggest that intravitreal injection of anti-HMGB1 Ab reduced HMGB1-dependent inflammatory signaling and mediated RGC neuroprotection.


Assuntos
Glaucoma , Proteína HMGB1 , Animais , Modelos Animais de Doenças , Glaucoma/metabolismo , Humanos , Imunoglobulina G , Pressão Intraocular , Proteômica , Ratos
18.
Int J Mol Sci ; 23(8)2022 Apr 11.
Artigo em Inglês | MEDLINE | ID: mdl-35457041

RESUMO

The contributory roles of vitamin D in ocular and visual health have long been discussed, with numerous studies pointing to the adverse effects of vitamin D deficiency. In this paper, we provide a systematic review of recent findings on the association between vitamin D and different ocular diseases, including myopia, age-related macular degeneration (AMD), glaucoma, diabetic retinopathy (DR), dry eye syndrome (DES), thyroid eye disease (TED), uveitis, retinoblastoma (RB), cataract, and others, from epidemiological, clinical and basic studies, and briefly discuss vitamin D metabolism in the eye. We searched two research databases for articles examining the association between vitamin D deficiency and different ocular diseases. One hundred and sixty-two studies were found. There is evidence on the association between vitamin D and myopia, AMD, DR, and DES. Overall, 17 out of 27 studies reported an association between vitamin D and AMD, while 48 out of 54 studies reported that vitamin D was associated with DR, and 25 out of 27 studies reported an association between vitamin D and DES. However, the available evidence for the association with other ocular diseases, such as glaucoma, TED, and RB, remains limited.


Assuntos
Retinopatia Diabética , Glaucoma , Degeneração Macular , Miopia , Deficiência de Vitamina D , Retinopatia Diabética/complicações , Olho , Glaucoma/complicações , Glaucoma/etiologia , Humanos , Degeneração Macular/complicações , Degeneração Macular/etiologia , Vitamina D , Deficiência de Vitamina D/complicações , Deficiência de Vitamina D/epidemiologia , Vitaminas
19.
Int J Mol Med ; 49(6)2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-35417030

RESUMO

To explore the role of atorvastatin in regulating intraocular pressure (IOP) in glaucoma in vivo, and to investigate its related molecular pathway in vitro, an ocular hypertension model was generated by intravitreal injection of an adenoviral vector encoding transforming growth factor (TGF)­ß2 in the right eye of BALB/cJ mice, while the left was treated with an empty control adenovirus. To determine its anti­intraocular hypertension role, these induced hyper­IOP mice were gavaged with atorvastatin (20 mg/kg/day). Furthermore, extracellular matrix (ECM) factors were examined in the primary human trabecular meshwork (HTM) cells followed atorvastatin (0~200 µM) treatment in vitro. Whole genome microarray was employed to identify potential therapeutic target molecules associated with ECM regulation. Unilateral murine ocular hypertension was induced, via intravitreal injection of the adenoviral vector carrying the human TGF­ß2 gene (Ad.hTGF­ß2226/228), raising IOP from 12±1.6 to 32.3±0.7 mmHg (n=6, P<0.05) at day 15, which plateaued from day 15 to 30. Atorvastatin administration from day 15 to 30 decreased IOP from 32.3±0.7 to 15.4±1.1 mmHg (n=6, P<0.05) at day 30. Additionally, atorvastatin administration changed the morphology of cultured HTM cells from an elongated and adherent morphology into rounded, less elongated and less adherent cells, accompanied with suppressed expression of ECM. Gene Ontology and Genome analysis revealed that FGD4 (FYVE, RhoGEF and PH domain containing 4) might be a key factor contributing to these changes. Our data demonstrated that atorvastatin reduced TGF­ß2­induced ocular hypertension in vivo, perhaps via modifying cellular structure and decreasing ECM, using the FGD4 signaling pathway, as demonstrated in HTM cells. Our findings provide some useful information for the management of glaucoma, with statin therapy revealing a potential novel therapeutic pathway for glaucoma treatment.


Assuntos
Atorvastatina , Glaucoma , Proteínas dos Microfilamentos , Hipertensão Ocular , Animais , Atorvastatina/farmacologia , Células Cultivadas , Matriz Extracelular/metabolismo , Glaucoma/metabolismo , Pressão Intraocular , Camundongos , Proteínas dos Microfilamentos/genética , Hipertensão Ocular/induzido quimicamente , Hipertensão Ocular/tratamento farmacológico , Hipertensão Ocular/metabolismo , Malha Trabecular/metabolismo , Fator de Crescimento Transformador beta2/farmacologia
20.
J Glaucoma ; 31(5): 322-328, 2022 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-35476645

RESUMO

PRCIS: Although there was little difference in overall vision-related quality of life (VRQOL) between patients with normal tension glaucoma (NTG) and primary open-angle glaucoma (POAG) after controlling for confounding factors, POAG tended to have poorer VRQOL, especially in social functioning and dependency, than NTG. PURPOSE: The fundamental goal of treatment of patients with glaucoma is to preserve their VRQOL. The aim of this study was to compare VRQOL between patients with NTG and those with POAG. MATERIALS AND METHODS: The self-reported National Eye Institute Visual Function Questionnaire (NEI VFQ-25) survey was performed, including clinical, demographic, and socioeconomic data from 506 Korean patients with NTG and 287 with POAG. The mean deviation of the integrated binocular visual field was calculated using the best location method. The NEI VFQ-25 results were evaluated by Rasch analysis to control item difficulty and variation in individual response ability. Propensity score matching was used to control for various confounding factors affecting VRQOL. RESULTS: Although patients with POAG tended to have worse VRQOL than those with NTG, there was no statistically significant between-group difference in ocular pain, near and distance activities, mental health, role difficulties, ability to drive, and the overall composite score. However, the social functioning (P=0.016) and dependency (P=0.026) were significantly poorer in POAG patients. CONCLUSIONS: Overall VRQOL in patients with NTG and POAG was found to be similar. However, social functioning and dependency were significantly worse in those with POAG. These findings are relevant to supporting glaucoma patients.


Assuntos
Glaucoma de Ângulo Aberto , Glaucoma , Glaucoma de Baixa Tensão , Humanos , Pressão Intraocular , Qualidade de Vida/psicologia
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