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1.
Medicine (Baltimore) ; 99(7): e19149, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32049840

RESUMO

This study aimed to compare various visual function parameters for evaluating the quality of life (QOL) of patients with advanced glaucoma with low vision.In total, 44 eyes of advanced glaucoma patients with low vision were included in this cross-sectional study. A moving pattern edge band program was used to assess edge detection ability and the low vision quality-of-life (LVQOL) questionnaire was used for evaluating QOL scores of subjects. Correlation analyses between QOL scores and visual functional parameters including pattern edge band unit, visual acuity (VA), and Mean deviation (MD) of perimetry were performed. The areas under receiver operating characteristic curves (AUROCs) of diverse visual functional parameters were calculated.VA and pattern edge band unit were related to LVQOL score in all subjects. For patients with a decimal VA lower than 0.1, only the pattern edge band showed a significant correlation with the QOL associated with distant activities (P = .031). However, the MD of perimetry was not related to the QOL score. After sorting subjects into 2 groups according to the LVQOL score, VA and pattern edge band unit were significantly different (P < .01 and P = .029, respectively). The AUROC for edge detection ability using pattern edge band was higher than MD of perimetry.Assessment of edge detection ability using pattern edge band was meaningful for predicting QOL associated with visual performance in patients with far-advanced glaucoma. For these patients, edge detection could be used as an additional parameter for visual function with traditional VA and perimetry.


Assuntos
Glaucoma/complicações , Qualidade de Vida , Testes Visuais , Baixa Visão/psicologia , Idoso , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Baixa Visão/etiologia
2.
Eur J Ophthalmol ; 30(1): 168-174, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30563364

RESUMO

PURPOSE: To report on the clinical presentation and surgical treatment (procedure and outcome(s)) of glaucoma in children with facial port wine stain. MATERIALS AND METHODS: This is a retrospective chart review of children with facial port wine stain referred to Alexandria University paediatric ophthalmology practice from 2005 to 2016. The charts of 22 children (44 eyes) with facial port wine stain were reviewed. The data extracted included demographics, results of ophthalmic examination findings and treatment(s). The main outcome measures were the number of eyes stratified as glaucoma, glaucoma suspects and no glaucoma at the initial and final presentations. RESULTS: The average age of presentation was 18.2 (±33.9) months. After a follow-up of over 16.1 (±24.8) months, there were 34%, 30% and 36% of the study eyes diagnosed as glaucoma, glaucoma suspects and no glaucoma, respectively with mean ± standard deviation of intraocular pressure of 20.6 ± 5.1, 13.6 ± 5.4 and 7.5 ± 1.7 mmHg. The majority (91%) of eyes presenting with glaucoma had clear corneas. In total, 11 eyes were operated upon for glaucoma. The recorded success rate was 91%. Two eyes developed a postoperative exudative choroidal detachment, of which one resolved spontaneously and the other was successfully managed by intravitreal gas injection. CONCLUSION: Glaucoma is a significant ocular hazard in children with facial port wine stain that may not be evident on the initial presentation. The presentation is usually with a clear cornea and surgical intervention is associated with a high success rate and a low rate of complications.


Assuntos
Glaucoma/complicações , Mancha Vinho do Porto/complicações , Síndrome de Sturge-Weber/complicações , Criança , Pré-Escolar , Feminino , Glaucoma/diagnóstico , Glaucoma/cirurgia , Humanos , Lactente , Pressão Intraocular/fisiologia , Injeções Intravítreas , Masculino , Hipertensão Ocular/complicações , Hipertensão Ocular/diagnóstico , Hipertensão Ocular/cirurgia , Período Pós-Operatório , Estudos Retrospectivos , Tonometria Ocular , Trabeculectomia/métodos
3.
Rom J Ophthalmol ; 63(3): 268-272, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31687630

RESUMO

Purpose. To report a case of malignant glaucoma in a pseudophakic female patient, with no history of glaucoma, resolved through pars plana anterior vitrectomy. Case presentation. An 80-year-old female patient presented in our Emergency Department after a five-day history of pain in her left eye (LE). In the last day, the patient noticed marked visual loss and ocular pain. Visual acuity was light perception and Goldman tonometry was 80 mmHg in her LE. The biomicroscopy revealed absent peripheral and central anterior chamber (AC) and posterior chamber (PC) pseudophakia. Posterior segment ecography showed no vitreous or choroidal abnormalities. A peripheral laser YAG iridotomy was made and the patient was treated with intravenous 20% mannitol, topical timolol, topical brimonidine, and topical cycloplegics. 12 hours later, despite a patent iridotomy in the LE eye, intraocular pressure (IOP) was 55 mmHg, absent AC with severe corneal edema. The diagnosis of pseudophakic malignant glaucoma was made and laser YAG capsulotomy was performed with no resolution of symptoms and signs. 24 hours later, we performed pars plana anterior vitrectomy. Postoperatively, the AC depth increased and the IOP decreased to 20mmHg. After a week, the patient was discharged with hand movement perception visual acuity in her LE, 20 mmHg IOP, reduced corneal edema, normal depth AC. After a month, the corneal edema resolved, the visual acuity was 2/50, IOP was 20mmHg, and the AC had a normal depth. Conclusion. Malignant glaucoma is a sight threatening condition, reported in pseudophakic eyes. Although, literature describes cases solved by cycloplegics and laser YAG capsulotomy, our patient needed pars plana anterior vitrectomy for the resolution of symptoms and signs.


Assuntos
Glaucoma/cirurgia , Pressão Intraocular/fisiologia , Terapia a Laser/métodos , Pseudofacia/cirurgia , Acuidade Visual , Vitrectomia/métodos , Idoso de 80 Anos ou mais , Feminino , Glaucoma/complicações , Glaucoma/diagnóstico , Humanos , Pseudofacia/complicações , Pseudofacia/diagnóstico , Lâmpada de Fenda
4.
Vestn Oftalmol ; 135(5): 38-45, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31714511

RESUMO

PURPOSE: To assess the effect of intravitreal administration of anti-VEGF drugs ranibizumab and aflibercept on the functional state of the visual pathway in patients with neovascular age-related macular degeneration (nAMD) and primary open-angle glaucoma (POAG) using the method of recording visual evoked potentials (VEP). MATERIAL AND METHODS: A total of 54 patients (54 eyes) with nAMD and POAG were examined. The control group consisted of 39 healthy patients (39 eyes). The study included 24 patients (24 eyes) with stage IA POAG, 23 patients (23 eyes) with stage IIA POAG, 7 patients (7 eyes) with stage IIIA POAG. All patients with nAMD and POAG were given intravitreal injection of anti-VEGF drug: 35 patients received ranibizumab, 19 patients received aflibercept. Injections were performed monthly for 3 months. Ophthalmologic examination included visometry, biomicroscopy, retinal OCT using SPECTRALIS tomograph ('Heidelberg Engineering GmbH', Germany). VEP were recorded on EP-1000 Multifocal ('Tomey', Germany). All ophthalmologic studies were performed prior to administration of the anti-VEGF preparation and after the 3rd injection. RESULTS: After the third intravitreal injection of anti-VEGF drugs, best corrected visual acuity (BCVA) increased to 0.46±0.1 (p=0.001). According to OCT, central retinal thickness decreased by an average of 110.6 µm, the total volume of the retina decreased by 1.3 mm3, total thickness RNFL - by 3.8 µm (p<0.05). A decrease in the peak latency and an increase in the amplitude of the component P100 of VEP were noted. Statistically significant differences in indicators of VEP between antiangiogenic drugs ranibizumab and aflibercept were not detected (p>0.05). CONCLUSION: Intravitreal administration of anti-VEGF drugs ranibizumab and aflibercept has no negative influence on the functional state of the visual pathway in patients with nAMD and POAG. Intravitreal injections of ranibizumab and aflibercept can be considered a safe treatment option for patients with nAMD and POAG.


Assuntos
Glaucoma , Degeneração Macular , Vias Visuais , Inibidores da Angiogênese , Potenciais Evocados Visuais , Seguimentos , Glaucoma/complicações , Humanos , Injeções Intravítreas , Degeneração Macular/complicações , Ranibizumab , Estudos Retrospectivos , Tomografia de Coerência Óptica , Resultado do Tratamento , Acuidade Visual
5.
Korean J Ophthalmol ; 33(5): 422-429, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31612652

RESUMO

PURPOSE: We investigated changes in the thickness of the peripapillary retinal nerve fiber layer (RNFL) following the onset of an epiretinal membrane (ERM) in glaucoma patients. METHODS: Among regularly monitored glaucoma patients, patients with a newly diagnosed ERM were consecutively enrolled. Before and after the onset of ERM, the RNFL thickness was measured using spectral domain optical coherence tomography, and a visual field examination was performed using a Humphrey field analyzer. Changes in RNFL thickness parameters and global indices of the visual field analyzer were assessed. RESULTS: In a total of 28 eyes from 28 patients, the average RNFL thickness increased by a mean of 4.0 ± 7.4 µm (p = 0.009) after ERM onset. There was an increase in the superior, nasal, and temporal quadrant RNFL thicknesses, and the change in the temporal RNFL thickness was significant (14.4 ± 21.2 µm, p < 0.001). However, the inferior RNFL thickness decreased by -0.6 ± 7.5 µm (p = 0.116). In the visual field examination, the mean deviation decreased significantly by -0.8 ± 1.7 dB (p = 0.038), from -14.6 to -15.4 dB. CONCLUSIONS: A significant increase in average RNFL thickness was detected following ERM onset in glaucoma patients, although there was deterioration of the mean deviation in the visual field. When ERM occurs in glaucoma patients, clinicians should be aware that RNFL thickness measurements obtained with a spectral domain optical coherence tomography may underestimate the status of glaucomatous optic neuropathy.


Assuntos
Membrana Epirretiniana/diagnóstico , Glaucoma/diagnóstico , Células Ganglionares da Retina/patologia , Tomografia de Coerência Óptica/métodos , Adulto , Idoso , Progressão da Doença , Membrana Epirretiniana/etiologia , Membrana Epirretiniana/fisiopatologia , Feminino , Seguimentos , Glaucoma/complicações , Glaucoma/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Fibras Nervosas/patologia , Disco Óptico/patologia , Estudos Retrospectivos , Campos Visuais/fisiologia
6.
Middle East Afr J Ophthalmol ; 26(3): 127-132, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31619898

RESUMO

PURPOSE: This study sought to determine the quality of life (QOL) of patients with visual impairment in Federal Medical Centre, Owerri, Imo State, with a view to making recommendations for comprehensive management of patients. MATERIALS AND METHODS: This was a hospital-based, cross-sectional study carried out at the Eye Clinic of Federal Medical Centre, Owerri, Imo State, Southeast Nigeria. New patients aged 18 years and older were consecutively recruited. Data were obtained using a semi-structured questionnaire and a World Health Organization's QOL Scale-Short Form (WHO-QOL-BREF). Participants had comprehensive eye examinations, and data were analyzed using the Statistical Package for the Social Sciences version 22. RESULTS: One hundred and eight (53.7%) females and 93 (46.3%) males with a mean age of 55.92 ± 16.94 years participated in the study. The major causes of visual impairment were uncorrected refractive error, glaucoma, and cataract. Glaucoma (6.5%) was the leading cause of blindness. The overall QOL score was 61.10 ± 19.75, with the lowest mean score in the environmental domain. With increasing visual impairment, there was a 19.1% reduction in QOL. QOL was also affected by age, duration of visual impairment, and history of poor near vision. CONCLUSION: The leading causes of visual impairment and blindness in this study are avoidable and treatable. Health education, appropriate intervention, and support groups should be encouraged. This may serve to reduce the burden of visual impairment and improve the QOL of patients.


Assuntos
Cegueira/psicologia , Qualidade de Vida/psicologia , Baixa Visão/psicologia , Pessoas com Deficiência Visual/psicologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Cegueira/etiologia , Catarata/complicações , Estudos Transversais , Feminino , Glaucoma/complicações , Educação em Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Nigéria , Erros de Refração/complicações , Inquéritos e Questionários , Baixa Visão/etiologia , Acuidade Visual/fisiologia , Adulto Jovem
7.
Middle East Afr J Ophthalmol ; 26(2): 101-106, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31543668

RESUMO

BACKGROUND: This study was undertaken to ascertain the current magnitude and causes of blindness and visual impairment in persons aged 50 years and over and to assess the impact of a 10-year eye care program in Sokoto State, Nigeria. METHODS: A rapid assessment of avoidable blindness (RAAB) survey (in persons 50 years and over) was conducted in 2016. Participants were selected in Wurno health zone using a two-stage cluster randomized sampling with probability proportional to size. Operational definitions were based on RAAB and World Health Organization eye examination record definitions. Eye care program documents were reviewed and data from a baseline survey undertaken in 2005 were reanalyzed. RESULTS: A response of 89.1% (2405 of 2700 participants) was obtained in the 2016 survey. With available correction, the unadjusted prevalence of blindness was 7.7% (95% confidence interval [CI]: 6.4, 8.9). The odds of blindness were 1.8 times higher in females than males (95% CI: 1.3, 2.4; P < 0.001). Major causes of blindness were cataract (48.9%) corneal disease (20.1%), glaucoma (10.3%), and uncorrected refractive error/aphakia (8.7%). The age- and sex-adjusted prevalence of blindness has declined from 11.6% (95% CI: 7.4, 17.0) in 2005 to 6.8% (95% CI: 5.6, 8.0%) in 2016. CONCLUSION: The blindness prevalence is high, and the major causes are avoidable in the health zone. The findings suggest that investments in the program over the last 10 years might have led to almost a halving in the prevalence of blindness in th e population. However, the small sample size of persons 50+ years from Wurno zone in the 2005 survey necessitate caution when comparing the 2005 and the 2016 surveys.


Assuntos
Cegueira/epidemiologia , Assistência à Saúde/estatística & dados numéricos , Baixa Visão/epidemiologia , Pessoas com Deficiência Visual/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Cegueira/etiologia , Catarata/complicações , Doenças da Córnea/complicações , Assistência à Saúde/organização & administração , Feminino , Glaucoma/complicações , Inquéritos Epidemiológicos , Humanos , Masculino , Pessoa de Meia-Idade , Nigéria/epidemiologia , Exame Físico , Prevalência , Erros de Refração/complicações , Baixa Visão/etiologia
8.
Top Companion Anim Med ; 36: 4-8, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31472726

RESUMO

This report describes a 10-month-old dog with a sudden loss of vision and severe dyspnoea. The ocular examination revealed bilateral panuveitis, lens subluxation, secondary glaucoma, and retinal detachment. In addition, the ocular ultrasound showed in the vitreous body of the right eye, a small doubled-lined foreign body compatible with an intraocular parasite. Radiographs of the thorax revealed an increased opacity with mixed lung pattern (alveolar and bronchial) and thoracic ultrasonography showed several subpleural nodules. The presence of Angiostrongylus vasorum first stage larvae was confirmed with 324 larvae per gram of feces and an antigen test for the parasite (AngioDetect, IDEXX) also yielded a positive result. The severe and irreversible ocular lesions described in this case enhanced the complexity of the clinical picture of canine angiostrongylosis. Infection with the parasite should be included in the list of differential diagnoses for ocular uveitis to avoid potentially serious complications related to a missed or delayed diagnosis.


Assuntos
Angiostrongylus/isolamento & purificação , Doenças do Cão/parasitologia , Oftalmopatias/veterinária , Infecções por Strongylida/veterinária , Animais , Doenças do Cão/diagnóstico , Doenças do Cão/tratamento farmacológico , Cães , Oftalmopatias/diagnóstico , Oftalmopatias/tratamento farmacológico , Oftalmopatias/parasitologia , Fezes/parasitologia , Feminino , Glaucoma/complicações , Itália , Subluxação do Cristalino/parasitologia , Subluxação do Cristalino/veterinária , Pneumopatias Parasitárias/diagnóstico por imagem , Pneumopatias Parasitárias/veterinária , Pan-Uveíte/parasitologia , Pan-Uveíte/veterinária , Descolamento Retiniano/parasitologia , Descolamento Retiniano/veterinária , Infecções por Strongylida/diagnóstico , Infecções por Strongylida/tratamento farmacológico
9.
Curr Opin Ophthalmol ; 30(6): 513-524, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31483320

RESUMO

PURPOSE OF REVIEW: To summarize the ocular and systemic associations of floppy eyelid syndrome (FES) as well as provide an up-to-date review on the pathogenesis and treatment strategies. RECENT FINDINGS: Virtually all patients with FES have obstructive sleep apnea (OSA). However, a significantly lower proportion of patients with OSA have FES. Although some studies demonstrate no association between OSA and FES, almost all show at least an association with increased eyelid laxity, which may be a less severe form of FES. FES has also been associated with keratoconus (KCN) and glaucoma. Decreased corneal hysteresis has been found in FES, KCN, glaucoma, and OSA and may be related to matrix metalloproteinase (MMP) upregulation. Hypoxia-reperfusion injury, leptin resistance, and mechanical forces all may lead to increased MMP activity, contributing to elastin breakdown in the tarsus and other tissues throughout the body. Management of FES begins with investigation for OSA. Treating OSA with continuous positive airway pressure (CPAP) or surgical uvulopalatoplasty may improve FES. Surgical treatments for FES should reduce horizontal eyelid laxity while maximizing the stability of the tarsus. Collagen crosslinking may prove a helpful modality for stabilizing the tarsus in the future. SUMMARY: FES is associated with OSA, glaucoma, and KCN. MMP upregulation and lower corneal hysteresis have been found in these conditions, pointing toward a potential common pathogenesis.


Assuntos
Doenças Palpebrais/etiologia , Glaucoma/complicações , Ceratocone/complicações , Apneia Obstrutiva do Sono/complicações , Doenças Palpebrais/fisiopatologia , Glaucoma/fisiopatologia , Humanos , Ceratocone/fisiopatologia , Apneia Obstrutiva do Sono/fisiopatologia , Síndrome
10.
Curr Pharm Biotechnol ; 20(12): 1037-1043, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31393242

RESUMO

BACKGROUND & OBJECTIVE: Corneal endothelial cells (ECD) are characterized by limited regenerative potential, which is additionally impaired in patients with diabetes. This retrospective study included 27 patients aged 58.1±13.6, 16 female and 11 males, who underwent 23-gauge vitrectomy in combination with cataract surgery (phacovitrectomy) and further Ex-PRESS shunt implantation throughout 2013-2017 at St. Barbara Hospital in Sosnowiec, Poland. METHODS: In our study, we distinguished 4 periods: initial period; post phacovitrectomy and removal of oil tamponade; and 3 and 12 months post implantation of the Ex-PRESS shunt. Statistical analysis was performed at the level of statistical significance of p<0.05. It included an analysis of variance (ANOVA) and Tukey's post-hoc test in order to determine the differences in the density of ECD cells/mm2 between the periods of observation. The paired-samples t-Student test was also performed to determine whether the differences in visual acuity values before and after PPV and before and after Ex-PRESS shunt were statistically significant. RESULTS: The initial count of ECD cells was 2381.1±249, which decreased to 1872.8±350.7 cell/mm2 and finally to 1677.9±327 at the endpoint. Differences in the density of ECD cells/mm2 were observed to be statistically significant between the periods: after PPV vs. initial number of ECD (p = 0.000138); before 3 months after Ex-PRESS shunt vs. initial number of ECD (p = 0.000138); 12 months after Ex- PRESS shunt vs. initial number of ECD (p = 0000138). Analyzing the changes in visual acuity, we observed a deterioration both before and 3 months after Ex-PRESS shunt (p = 0.007944) and before and after PPV (p = 0.060334). In turn, correlation analysis indicated that there is a statistically significant, moderate, positive relationship. The relationship between visual acuity after Ex-PRESS shunt and ECD cells/mm2 density turned out to be statistically significant (r = +0.521381; p < 0.05). CONCLUSION: Regardless of the period of observation and the choice of ophthalmic treatment of diabetic complications, we observed a decrease in the number of ECD cells and a deterioration in visual acuity. It is, therefore, reasonable to provide the patient with complete information about the proposed procedures and to consider the risk-benefit balance.


Assuntos
Córnea/cirurgia , Diabetes Mellitus Tipo 2/patologia , Células Endoteliais/patologia , Implantes para Drenagem de Glaucoma , Glaucoma/cirurgia , Facoemulsificação , Vitrectomia , Adulto , Idoso , Contagem de Células , Córnea/irrigação sanguínea , Diabetes Mellitus Tipo 2/cirurgia , Feminino , Glaucoma/complicações , Implantes para Drenagem de Glaucoma/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Facoemulsificação/efeitos adversos , Estudos Retrospectivos , Acuidade Visual , Vitrectomia/efeitos adversos
11.
Artigo em Inglês | MEDLINE | ID: mdl-31416136

RESUMO

The purpose of the current study was to evaluate the incidence of glaucoma in patients diagnosed with sensorineural hearing loss (SNHL) via the application of the National Health Insurance Research Database in Taiwan. A retrospective cohort study was conducted. Patients with a diagnosis of SNHL were enrolled in the study group after an exclusion procedure and a propensity score matched group without SNHL was served as the control group with a 1:2 ratio. The main outcome was regarded as the emergence of glaucoma diagnostic codes. Cox proportional hazard regression was applied to analyze the incidence and adjusted hazard ratio (aHR) of glaucoma in the multivariate model. A total of 15,686 patients diagnosed with SNHL were enrolled in the study group while another 31,372 non-SNHL individuals served as the control group. There were 444 glaucoma events in the study group and 647 glaucoma events in those non-SNHL individuals after the follow-up interval of 16 years. The study group demonstrated a significantly higher aHR compared to the control group after adjusting for multiple possible risk factors. In the subgroup analysis, both the normal tension glaucoma and angle closure glaucoma subgroups revealed a higher aHR in the study group. In conclusion, the patients with SNHL demonstrated a higher incidence of developing glaucoma. Moreover, the incidence was more prominent for patients diagnosed with normal tension glaucoma and angle closure glaucoma.


Assuntos
Glaucoma/complicações , Glaucoma/epidemiologia , Perda Auditiva Neurossensorial/epidemiologia , Perda Auditiva Neurossensorial/etiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Seguimentos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Pontuação de Propensão , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Fatores de Risco , Taiwan/epidemiologia
12.
Klin Monbl Augenheilkd ; 236(9): 1139-1155, 2019 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-31412384

RESUMO

Pseudoexfoliation (PEX) syndrome is a common, worldwide occurring and age-related disorder characterised by the deposition of extracellular fibrillar material. It is a systemic disease with significant ocular manifestations, including cataract and glaucoma. All structures of the anterior segment are affected leading to multiple specific findings in slit lamp examination. The most prominent findings are white, dandruff like deposits on the anterior surface of the lens or the pupillary border of the iris. Furthermore, PEX syndrome is the most common identifiable cause of open angle glaucoma. PEX glaucoma generally takes a more rapidly progressive course than primary open angle glaucoma. Patients therefore typically need earlier surgical intervention. PEX syndrome is often accompanied by nuclear cataract formation. Cataract extraction tends to be complicated and remains a challenge. Several technique modifications and new devices help to reduce the complication rate. The purpose of this paper is to summarize information regarding ocular manifestations of PEX-syndrome to facilitate an early diagnosis and to present a general view of the treatment of PEX glaucoma.


Assuntos
Extração de Catarata , Catarata , Síndrome de Exfoliação , Glaucoma de Ângulo Aberto , Glaucoma , Síndrome de Exfoliação/complicações , Glaucoma/complicações , Humanos
13.
Medicine (Baltimore) ; 98(26): e16215, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31261575

RESUMO

RATIONALE: Optic disk hemorrhage has been closely correlated with glaucoma for its development and progression. Phacoemulsification surgery results in large intraocular pressure (IOP) fluctuation. We report a case of optic disk hemorrhage and consequently progressive vitreous hemorrhage after an unsuccessful phacoemulsification surgery in an advanced normal tension glaucoma (NTG) patient. PATIENT CONCERNS: An advanced NTG patient of 82 years old with chronic hypertension underwent an unsuccessful phacoemulsification surgery complicated by posterior capsule rupture. During the postoperative 2 weeks, recurrent episodes of fresh hyphema occurred and B ultrasonography scan revealed the progressive vitreous hemorrhage. The IOP went out of control under the maximum tolerable IOP-lowering medications. DIAGNOSIS: Vitreous hemorrhage after phacoemulsification in an advanced NTG patient. INTERVENTIONS: Vitrectomy was performed to search for the cause of the progressive vitreous hemorrhage. After removal of the thick vitreous hemorrhage, a fresh spot of optic disk hemorrhage was detected at the nasal margin of the significantly-cupping disk. OUTCOMES: Postoperatively, the hemorrhagic vitreous opacity gradually resolved and the IOP remained stable at 10 ∼13 mmHg with topical prostaglandin analogue drops. Fundus examination revealed the dilated disk vessel with localized angiomatous change at the nasal disk margin. LESSONS: Severe optic disk hemorrhage may occur after phacoemulsification in advanced glaucoma patients. Systemic vascular factors, such as chronic hypertension and old age, and surgical complications, such as posterior capsule rupture and postoperative IOP elevation, would further increase the risk. For phacoemulsification in advanced glaucoma cases, extra care should be taken to control intraoperative IOP fluctuations and monitor postoperative IOP.


Assuntos
Glaucoma/complicações , Disco Óptico , Facoemulsificação/efeitos adversos , Complicações Pós-Operatórias/etiologia , Hemorragia Retiniana/etiologia , Hemorragia Vítrea/etiologia , Idoso de 80 Anos ou mais , Humanos , Masculino
14.
Invest Ophthalmol Vis Sci ; 60(8): 3204-3214, 2019 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-31335946

RESUMO

Purpose: The effective management of glaucoma is hindered by an incomplete understanding of its pathologic mechanism. While important, intraocular pressure (IOP) alone is inadequate in explaining glaucoma. Non-IOP-mediated risk factors such as cerebrospinal fluid (CSF) pressure have been reported to contribute to glaucomatous optic neuropathy. Due to the difficulty associated with experimental measurement of the salient variables, such as the retrobulbar CSF pressure, porosity of the subarachnoid space (SAS), and especially those concerned with the perioptic SAS, there remains a limited understanding of the CSF behavior contributing to the translaminar pressure gradient (TLPG), hypothesized to be a critical factor in the development of glaucoma. Method: An integrated compartmental model describing the intracranial and orbital CSF dynamics, coupled with intraocular dynamics, is developed based on first principles of fluid mechanics. A sensitivity analysis is performed to identify anatomic characteristics that significantly affect the retrobulbar subarachnoid space (RSAS) pressure and, consequently, the TLPG. Results: Of the 28 parameters considered, the RSAS pressure is most sensitive to CSF flow resistance in the optic nerve SAS and the potential lymphatic outflow from the optic nerve SAS into the orbital space. A parametric study demonstrates that a combination of resistance in the range of 1.600 × 1012 - 1.930 × 1012 Pa s/m3 (200.0 - 241.3 mm Hg min/mL) with 5% to 10% lymphatic CSF outflow yields RSAS pressures that are consistent with the limited number of studies in the literature. Conclusions: The results suggest that a small percentage of lymphatic CSF outflow through the optic nerve SAS is likely. In addition, flow resistance in the orbital CSF space, hypothesized to be a function of patient-specific optic nerve SAS architecture and optic canal geometry, is a critical parameter in regulating the RSAS pressure and TLPG.


Assuntos
Glaucoma/fisiopatologia , Pressão Intracraniana/fisiologia , Pressão Intraocular/fisiologia , Doenças do Nervo Óptico/fisiopatologia , Espaço Subaracnóideo/fisiopatologia , Glaucoma/complicações , Glaucoma/diagnóstico , Humanos , Doenças do Nervo Óptico/diagnóstico , Doenças do Nervo Óptico/etiologia , Espaço Subaracnóideo/diagnóstico por imagem , Tonometria Ocular
15.
Cesk Slov Oftalmol ; 74(5): 186-189, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31234631

RESUMO

The objective of the study was to determine whether there exists a difference in the central cornea thickness (CCT) in patients with hypertensive (HTG) and normotensive glaucoma (NTG), and subsequently, to compare the application of prostaglandins by corrected CCT (CCT correction) for both types of glaucoma. MATERIAL AND METHODS: 100 eyes of 50 patients (the average age of 67) with HTG and 100 eyes of 50 patients (the average age of 62.6) with NTG were examined. Antiglaucomatics, if indicated, were taken by the patients for at least the preceding five years. The excluding criteria in the study were: cornea diseases, post-laser procedure conditions and high ametropia. CCT was measured by means of Tomey Handy Pachymeter SP100 by the same physician. RESULTS: A two-sample t-test was applied in order to compare the measurement values of CCT and the subsequent correction of these values (CCT correction) in patients with HTG and NTG. The statistical evaluation showed that in case of both CCT and CCT correction, the values were lower in the group of NTG patients in comparison with HTG patients. With respect to CCT, the difference was statistically insignificant (NTG 554.9±35.7 vs. HTG 561.4 ± 32.7, p = 0.181). In case of CCT correction, the difference was more considerable, but still statistically insignificant (NTG 550.8 ± 35 vs. HTG 559.6 ± 33.1, p = 0.06). CONCLUSION: CCT was higher in NTG than in HTG; however, these values were statistically insignificant. A comparison of the application of prostaglandins of corrected CCT (CCT correction) for both types of glaucoma increased the difference, but this difference was still statistically insignificant. This difference was caused by an uneven representation of patients treated with prostaglandins in both groups. Key words: hypertensive glaucoma, normotensive glaucoma, central cornea thickness, prostaglandins.


Assuntos
Córnea , Glaucoma , Pressão Intraocular , Idoso , Córnea/patologia , Glaucoma/complicações , Humanos , Pessoa de Meia-Idade , Prostaglandinas Sintéticas
16.
Indian J Ophthalmol ; 67(7): 1089-1094, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31238418

RESUMO

Purpose: To clinically validate a new automated glaucoma diagnosis software RIA-G. Methods: A double-blinded study was conducted where 229 valid random fundus images were evaluated independently by RIA-G and three expert ophthalmologists. Optic nerve head parameters [vertical and horizontal cup-disc ratio (CDR) and neuroretinal rim (NRR) changes] were quantified. Disc damage likelihood scale (DDLS) staging and presence of glaucoma were noted. The software output was compared with consensus values of ophthalmologists. Results: Mean difference between the vertical CDR output by RIA-G and the ophthalmologists was - 0.004 ± 0.1. Good agreement and strong correlation existed between the two [interclass correlation coefficient (ICC) 0.79; r = 0.77, P < 0.005]. Mean difference for horizontal CDR was - 0.07 ± 0.13 with a moderate to strong agreement and correlation (ICC 0.48; r = 0.61, P < 0.05). Experts and RIA-G found a violation of the inferior-superior NRR in 47 and 54 images, respectively (Cohen's kappa = 0.56 ± 0.07). RIA-G accurately detected DDLS in 66.2% cases, while in 93.8% cases, output was within ± 1 stage (ICC 0.51). Sensitivity and specificity of RIA-G to diagnose glaucomatous neuropathy were 82.3% and 91.8%, respectively. Overall agreement between RIA-G and experts for glaucoma diagnosis was good (Cohen's kappa = 0.62 ± 0.07). Overall accuracy of RIA-G to detect glaucomatous neuropathy was 90.3%. A detection error rate of 5% was noted. Conclusion: RIA-G showed good agreement with the experts and proved to be a reliable software for detecting glaucomatous optic neuropathy. The ability to quantify optic nerve head parameters from simple fundus photographs will prove particularly useful in glaucoma screening, where no direct patient-doctor contact is established.


Assuntos
Técnicas de Diagnóstico Oftalmológico , Glaucoma/diagnóstico , Pressão Intraocular/fisiologia , Disco Óptico/patologia , Doenças do Nervo Óptico/diagnóstico , Software , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Método Duplo-Cego , Feminino , Glaucoma/complicações , Glaucoma/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Doenças do Nervo Óptico/etiologia , Curva ROC , Adulto Jovem
18.
J Obstet Gynaecol ; 39(8): 1037-1048, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31190583

RESUMO

Pregnancy is a normal state of physiological stress that induces significant changes in the human body, some of which can potentially affect the visual system. The pregnant state may exacerbate pre-existing ocular disorders (i.e. diabetic retinopathy or central serous retinopathy). Moreover, other systemic conditions related to pregnancy can induce ophthalmic disorders affecting the retina and the choroid, some of which are of acute nature. Increasing awareness and improving collaboration between ophthalmologists, obstetricians and internists can play a pivotal role in the management of complex conditions during pregnancy. Special attention should be given while prescribing medications or deciding about other diagnostic or therapeutic techniques. The purpose of this review is to summarise the physiologic and pathologic effects of pregnancy in the eyes, highlighting the most acute clinical entities that may be threatening for the vision or even the life of the mother and her baby.


Assuntos
Oftalmopatias/complicações , Oftalmopatias/fisiopatologia , Complicações na Gravidez/fisiopatologia , Córnea , Feminino , Feto/efeitos dos fármacos , Glaucoma/complicações , Humanos , Pressão Intraocular , Gravidez , Doenças Retinianas/complicações , Doenças Retinianas/fisiopatologia , Doenças Retinianas/cirurgia , Uveíte/complicações , Campos Visuais
19.
Graefes Arch Clin Exp Ophthalmol ; 257(9): 1955-1962, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31197448

RESUMO

PURPOSE: To compare the clinical characteristics and outcomes of eyes with unilateral disc hemorrhage (DH) in different locations. METHODS: This was a retrospective cohort study. DHs were classified by locations: the superior, superotemporal, inferotemporal, or inferior sectors of optic disc were classified as the susceptible area, while other sectors were defined as the less susceptible area. Structural and functional outcomes were analyzed by the Humphrey field analyzer and spectral domain optical coherence tomography. RESULTS: Forty-three eyes with DHs in the susceptible area were less myopic and had more peripapillary-type DH, larger cup-to-disc ratio, cup volume, and disc area. Thirty-three eyes with DHs in the less susceptible area had less association with RNFL defects, greater tilted ratio, and less torsion of the disc. Follow-up revealed that the change in sectoral RNFL (µm) thickness was significantly greater for DHs in the susceptible area within one year (- 6.0 ± 14.0 vs. 0.7 ± 13.0, p = 0.035) and two years (- 10.0 ± 17.4 vs. - 1.1 ± 7.6, p = 0.012), while the change in average RNFL thickness was not different. Eyes with DHs in the susceptible area had faster MD deterioration (dB/year) than those in the less susceptible area within four years (- 0.32 ± 0.51 vs. - 0.05 ± 0.45, p = 0.047). A total of 16.9% of eyes, all in the susceptible area, had localized VF progression at DH corresponding area. CONCLUSION: Disc hemorrhage in the superotemporal and inferotemporal regions had more subsequent structural and functional deterioration compared with the eyes with DHs in the temporal quadrant and nasal area.


Assuntos
Glaucoma/complicações , Disco Óptico/irrigação sanguínea , Doenças do Nervo Óptico/diagnóstico , Células Ganglionares da Retina/patologia , Hemorragia Retiniana/diagnóstico , Tomografia de Coerência Óptica/métodos , Campos Visuais/fisiologia , Feminino , Seguimentos , Glaucoma/diagnóstico , Glaucoma/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Fibras Nervosas/patologia , Doenças do Nervo Óptico/etiologia , Hemorragia Retiniana/etiologia , Estudos Retrospectivos , Acuidade Visual
20.
Acta Ophthalmol ; 97(7): 652-659, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31125174

RESUMO

To summarize epidemiological evidences on the association between glaucoma and the risk of retinal vein occlusion (RVO). Relevant studies were identified by searching in PubMed, EMBASE and Cochrane until February 2018. Fifteen eligible observational studies were aggregated in this analysis. All results were analysed and pooled using random effects models with 95% confidence intervals (CI). In all studies, the odds ratio (OR) of glaucoma as a risk factor for RVO was 4.01 (95% CI: 3.28-4.91). In RVO subtype-differentiated subgroup analyses (six studies), the pooled OR showed that glaucoma was associated with central retinal vein occlusion (CRVO) (OR: 6.21; 95% CI: 4.64-8.31), branch retinal vein occlusion (BRVO) (OR: 2.38; 95% CI: 1.77-3.19) and hemiretinal vein occlusion (HRVO) (OR: 4.60; 95% CI: 2.26-9.35). In glaucoma-classified subgroup analyses (five studies), primary open-angle glaucoma (POAG) (OR: 5.03; 95% CI: 3.97-6.37) and chronic open-angle glaucoma (COAG) (OR: 2.36; 95% CI: 1.39-4.02) were significant risk factors for RVO development. There was a plausible relationship between primary angle closure glaucoma (PACG) and RVO risk (OR: 1.85; 95% CI: 0.41-8.35); to be precise, the OR was 5.3 in PACG and CRVO risk (95% CI: 1.04-26.95; p = 0.045), while the OR was 0.65 in PACG and BRVO risk (95% CI: 0.07-6.27; p = 0.707). To sum up, this meta-analysis shows that glaucoma is associated with the risk of RVO. Glaucoma should be kept in mind when investigating patients with RVO in the clinic.


Assuntos
Glaucoma/complicações , Oclusão da Veia Retiniana/etiologia , Medição de Risco/métodos , Saúde Global , Humanos , Morbidade , Oclusão da Veia Retiniana/epidemiologia , Fatores de Risco
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