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1.
Curr Opin Ophthalmol ; 31(2): 132-138, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31922979

RESUMO

PURPOSE OF REVIEW: This review will provide an update on surgical techniques, outcomes, and complications for two new translimbal bleb-forming surgical glaucoma devices. RECENT FINDINGS: The XEN Gel Microstent and PreserFlo MicroShunt comprise a category of subconjunctival microinvasive glaucoma surgery developed with the aim of improving the predictability and safety profile of bleb-forming procedures. Both devices are made of noninflammatory material which limits postsurgical inflammation and scarring and have a valve-less intrinsic flow-limiting design, which decreases the risk of hypotony. There are various techniques of implantation for the XEN Gel Microstent each with their own advantages and disadvantages. SUMMARY: These devices have demonstrated promising outcomes in early experimental literature with similar intraocular pressure-lowering effects to traditional incisional surgery such as trabeculectomy or tube shunt surgery, but with fewer risks. Future randomized, prospective studies should be done to compare these gel stents and microshunts both to each other and to other traditional glaucoma surgeries.


Assuntos
Implantes para Drenagem de Glaucoma , Glaucoma/cirurgia , Stents , Túnica Conjuntiva/cirurgia , Glaucoma/fisiopatologia , Humanos , Pressão Intraocular/fisiologia , Implantação de Prótese , Tonometria Ocular , Trabeculectomia
2.
Zhonghua Yan Ke Za Zhi ; 56(1): 17-20, 2020 Jan 11.
Artigo em Chinês | MEDLINE | ID: mdl-31937059

RESUMO

Lamina cribrosa (LC) is considered as the original site of glaucomatous damage of axons of retinal ganglion cells, and therefore understanding the morphological changes in the LC will help to uncover the pathogenesis of glaucoma. Previous studies have indicated that the progress of glaucomatous optic neuropathy may be associated with the LC defects. Based on imaging by swept source optical coherence tomography B-Scan of the optic discs of patients with glaucoma, for the first time the spontaneous local LC defects have been found to balance the gradient between intraocular and cerebrospinal fluid pressures, which in turn can slow down the progress of glaucomatous optic neuropathy. This article provides the direct evidence supporting the role of intraocular and cerebrospinal fluid pressure gradient in the pathogenesis of glaucoma. This finding will increase our understanding of the mechanisms underlying glaucoma and help to develop novel strategies for its treatment and prognosis analysis. (Chin J Ophthalmol, 2020, 56: 17-20).


Assuntos
Glaucoma/diagnóstico , Glaucoma/fisiopatologia , Fibras Nervosas/patologia , Disco Óptico/patologia , Doenças do Nervo Óptico/diagnóstico , Células Ganglionares da Retina/patologia , Humanos , Pressão Intraocular , Tomografia de Coerência Óptica/métodos
3.
Zhonghua Yan Ke Za Zhi ; 56(1): 25-31, 2020 Jan 11.
Artigo em Chinês | MEDLINE | ID: mdl-31937060

RESUMO

Objective: To explore the effect of listening to different types of music on intraocular pressure (IOP) and the underlying mechanism. Methods: Cross-sectional study. Participants were students from Sun Yat-sen University from October 2017 to May 2018. The study consisted of two parts. In part 1, three types of music, including relaxing, positive and negative music, were used to find out which kind of music could reduce IOP. IOP was measured before and after listening to music. A self-report questionnaire was used to evaluate emotional responses to each type of music. In part 2, the diurnal curve of IOP at 6 time points of 7:30, 9:30, 11:30, 13:30, 15:30 and 17:30 was measured to determine when the individual's IOP peaked. On the second day, the subject listened to the music that could reduce IOP for 15 minutes at his/her IOP peak time. IOP, blood pressure (BP) and heart rate (HR) were measured, and morphology of the chamber angle was captured by swept-source optical coherence tomography before and after listening to music. Image J software was used to measure the diameter and cross-sectional area of Schlemm's canal (SC). Paired t-test was used to compare BP, HR and SC measurements prior to and post-music intervention. Results: In part 1, fifteen subjects, including 7 males and 8 females, were enrolled, with an average age of (23±1) years. Relaxation music could significantly lower IOP [(11.62±2.51) vs. (12.65±2.49) mmHg (1 mmHg=0.133 kPa) , t=-2.39, P=0.032]. Positive music had no effect on IOP [(12.45±2.77) vs. (12.65±2.46) mmHg, P=0.566] and negative music increased IOP [(12.13±1.60) vs. (10.86±2.78) mmHg, t=2.45, P=0.029]. Relaxation music could also arouse relaxation emotions in 14 out of 15 subjects. In part 2, 55 subjects, including 20 males and 35 females, were enrolled, with an average age of (26±10) years. The diurnal curve of IOP at 6 time points of every participant was measured. At each individual's peak time point, listening to relaxation music could decrease IOP [(12.66±4.32) vs. (13.99±4.47) mmHg, t=-5.72, P<0.01]. HR before and after listening to relaxation music was (79.57±10.43) and (75.57±9.62) beats/min, respectively (t=-3.68, P=0.001). Systolic BP was (118.11±13.92) and (110.82±12.67) mmHg, respectively (t=-5.10, P<0.01). Diastolic BP significantly declined from (70.07±9.96) to (66.14±8.48) mmHg (t=-3.65, P=0.001). Average SC area significantly increased after listening to relaxation music [(255.96±93.36) vs. (230.07±92.20) pixels, t=2.88, P=0.006]. Average SC diameter was (8.62±1.89) and (9.41±2.37) pixels, respectively before and after listening to relaxation music (t=3.39, P=0.001). Conclusion: Relaxation music reduces IOP in healthy subjects probably by dilating the SC.(Chin J Ophthalmol, 2020, 56: 25-31).


Assuntos
Glaucoma/fisiopatologia , Pressão Intraocular/fisiologia , Música , Adulto , Câmara Anterior , Estudos Transversais , Feminino , Humanos , Masculino , Esclera , Tonometria Ocular , Adulto Jovem
4.
Eur J Ophthalmol ; 30(1): NP5-NP6, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30295080

RESUMO

We present an unusual case of Sturge-Weber syndrome whose main clinical manifestations were nevus flammeus, seizures, glaucoma, and acoria. To our knowledge, the combination of Sturge-Weber syndrome and acoria has not been previously reported.


Assuntos
Anormalidades do Olho/diagnóstico , Iris/anormalidades , Síndrome de Sturge-Weber/diagnóstico , Anormalidades do Olho/fisiopatologia , Feminino , Glaucoma/diagnóstico , Glaucoma/fisiopatologia , Humanos , Pressão Intraocular/fisiologia , Pessoa de Meia-Idade , Mancha Vinho do Porto/diagnóstico , Mancha Vinho do Porto/fisiopatologia , Microscopia com Lâmpada de Fenda , Síndrome de Sturge-Weber/fisiopatologia , Acuidade Visual/fisiologia
5.
Eur J Ophthalmol ; 30(1): 162-167, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30301386

RESUMO

PURPOSE: To analyze the risk factors associated with early and late failure after goniotomy for primary pediatric glaucoma. METHODS: A retrospective study was done on infants who underwent goniotomy as the initial surgical procedure for primary pediatric glaucoma, and had a follow-up period ⩾48 months after surgery. Early and late failures were defined as intraocular pressure ⩾18 mmHg or signs of glaucoma progression before and after the end of first year, respectively. RESULTS: A total of 81 eyes of 47 children were included. The mean age at the time of surgery was 6.1 ± 6.7 months, 34 children (72.3%) were bilateral. The mean follow-up was 5.9 ± 2.8 years. Of the included eyes, 41 eyes (50.6%) showed success, 25 eyes (30.9%) showed an early failure, and 15 eyes (18.5%) showed a late failure. The mean survival time was 43 months. However, only surgery before the end of the first month and positive consanguinity of the parents (P < 0.01 for both) were independent risk factors for early and late failure of goniotomy for primary pediatric glaucoma. Patients with late failure showed a statistically significant lower preoperative intraocular pressure (P = 0.02). A larger preoperative corneal diameter and a male gender were associated with higher but statistically insignificant failure rates. There were no differences in the early or late failure rates between unilateral and bilateral cases. CONCLUSION: A positive consanguinity of the parents and surgery before the end of the first month are the major predictors of failure of goniotomy.


Assuntos
Previsões , Glaucoma/cirurgia , Pressão Intraocular/fisiologia , Complicações Pós-Operatórias/diagnóstico , Trabeculectomia/efeitos adversos , Pré-Escolar , Feminino , Seguimentos , Glaucoma/fisiopatologia , Humanos , Lactente , Recém-Nascido , Masculino , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Fatores de Risco , Tonometria Ocular , Resultado do Tratamento
6.
Curr Opin Ophthalmol ; 31(1): 15-22, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31688225

RESUMO

PURPOSE OF REVIEW: To review the current literature on the relationship between cataract extraction and intraocular pressure (IOP). RECENT FINDINGS: Cataract extraction can be an effective IOP lowering treatment for open and closed angle glaucoma as well as ocular hypertension. In comparative trials studying novel micro-invasive glaucoma surgeries in open angle glaucoma, the control group undergoing cataract extraction alone routinely achieved significant reductions in IOP and medication use postoperatively. Data from the Effectiveness in Angle Closure Glaucoma of Lens Extraction (EAGLE) trials have demonstrated that lens extraction is more effective at lowering IOP than peripheral iridotomy in patients with angle closure and should be considered as first line therapy. Additionally, patients in the ocular hypertension treatment study who underwent cataract extraction over the course of follow-up demonstrated significant IOP lowering sustained over 3 years. SUMMARY: Cataract extraction is an effective method to lower IOP in patients with glaucoma. Pressure lowering is more significant in eyes with narrow angles and those with higher baseline IOP levels. In eyes with angle closure, phacoemulsification alone can lower IOP, but when combined with GSL it may be even more effective. Recent large multicenter randomized trials have further elucidated the benefit of standalone cataract extraction to treat mild to moderate primary open angle glaucoma. Prospective and longitudinal studies that systematically investigate the variables that may influence degree and duration of IOP lowering post cataract extraction are lacking.


Assuntos
Extração de Catarata , Glaucoma/fisiopatologia , Pressão Intraocular/fisiologia , Humanos , Tonometria Ocular
7.
Bratisl Lek Listy ; 120(12): 945-949, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31855056

RESUMO

AIM: Secondary radiation-related side effects like secondary glaucoma (SG) of different modalities of treatment in uveal melanoma patients can appear in certain interval after therapy. This study describes the incidence of SG in patients after stereotactic radiosurgery (SRS). METHOD: The data of 230 patients treated by SRS were reviewed for SG. Group of 83 patients who were observed 5 years after treatment in one center with follow-up regularly at least 4 times per year were analyzed. RESULTS: In group of 83 patients with the median age 59 years, the median tumor volume at baseline was 0.41 cm3. The survival without SG after single dose SRS was 94 % in 1.5 year, 77 % in 2 years, 57 % in 3 years, 43 % in 3.5 years, and 18 % in 4.5 year after irradiation. In 6 patients (7.2 %) secondary enucleation was necessary due to SG. Both predictors (tumor volume and age of patient) at the time of SRS were not statistically significant by Cox proportional-hazards regression. CONCLUSIONS: Complications like SG in 5 year interval after irradiation can lead to secondary enucleation of the eye globe (Fig. 3, Ref. 44).


Assuntos
Glaucoma/epidemiologia , Melanoma/cirurgia , Aceleradores de Partículas , Lesões por Radiação/etiologia , Radiocirurgia/efeitos adversos , Radiocirurgia/métodos , Neoplasias Uveais/cirurgia , Feminino , Seguimentos , Glaucoma/etiologia , Glaucoma/fisiopatologia , Humanos , Incidência , Masculino , Melanoma/patologia , Pessoa de Meia-Idade , Estudos Retrospectivos , Eslováquia , Fatores de Tempo , Resultado do Tratamento , Carga Tumoral , Úvea/efeitos da radiação , Úvea/cirurgia , Neoplasias Uveais/patologia
8.
Invest Ophthalmol Vis Sci ; 60(14): 4556-4563, 2019 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-31675073

RESUMO

Purpose: To determine the importance of various vision parameters to functionality in glaucoma. Methods: Vision was measured using seven parameters: visual acuity (VA), contrast sensitivity (CS), integrated visual field (IVF), area under the log CS function (AULCSF), color vision, stereoacuity, and VA with noise (ViN). Likelihood ratio testing (LRT) determined if the full set of visual parameters significantly explained variability in 10 functional outcomes. For outcomes where the visual contribution was significant, dominance analysis determined the relative importance of the various visual parameters. Results: The analysis included 151 glaucoma patients. Mean age was 70 ± 6.8 years, and 47% were men. Significant visual contributions (LRT P < 0.05) were noted for glaucoma quality of life (GQL-15), reading speed, driving cessation, daily steps, and base of support while walking, but not for fear of falling, balance, gait velocity, stride velocity, and stride length while walking (LRT P > 0.05). The most important parameter (and percent contribution) to vision-explained variability were AULCSF for daily steps (45%), IVF for base of support (35%), VA for reading speed (34%), CS for GQL-15 (30%), and VA for driving cessation (26%). Conclusions: Measures of visual ability are important for several aspects of quality of life and functionality. The most important vision parameter for functionality differs depending on the domain studied. Reading and driving were explained by VA and IVF sensitivity. On the other hand, GQL-15 and daily steps were more heavily influenced by CS and AULCSF, which are rarely performed clinically.


Assuntos
Visão de Cores/fisiologia , Sensibilidades de Contraste/fisiologia , Glaucoma/fisiopatologia , Visão Ocular/fisiologia , Acuidade Visual/fisiologia , Campos Visuais/fisiologia , Idoso , Condução de Veículo , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Leitura , Perfil de Impacto da Doença , Inquéritos e Questionários
9.
Rom J Ophthalmol ; 63(3): 208-216, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31687621

RESUMO

Intraocular pressure (IOP) is known to have a definite circadian rhythm and its fluctuation correlates well with glaucoma progression. Twenty-four hour monitoring of IOP is an important indicator intraocular pressure fluctuation, as well as its peaks and spikes. However, Diurnal variation in IOP is well recognized but many decisions in glaucoma management are taken after one or two IOP measurements. Patient directed self-tonometry can be preformed through the twenty-four cycle, and has been the subject of an ongoing debate. In this review, we studied the history of self-tonometry devices and the present technologies for future. The results of various techniques studied revealed that a standardized method of conducting diurnal variation is yet to be ascertained, and for this, a proper research method is required.


Assuntos
Ritmo Circadiano/fisiologia , Glaucoma/fisiopatologia , Pressão Intraocular/fisiologia , Progressão da Doença , Humanos , Tonometria Ocular/métodos
10.
Rom J Ophthalmol ; 63(3): 277-280, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31687632

RESUMO

Purpose. to report malignant glaucoma and infectious crystalline keratopathy as complications after an uneventful Descemet Membrane Endothelial Keratoplasty (DMEK), and corneal clearance despite graft detachment after the surgery in a patient with pseudophakic bullous keratopathy. Method. A 81-year-old patient with high Intraocular Pressure (IOP) and flat anterior chamber with patent iridotomies after DMEK was diagnosed of malignant glaucoma. The medical approach being insufficient, the patient required a pars-plana vitrectomy, capsulo-hyaloidectomy, and surgical iridectomy. Results. The IOP was reduced and anterior chamber was repositioned after surgical management. Corneal clearance was observed despite graft detachment. The patient developed an infectious crystalline keratopathy after the resolution of malignant glaucoma. Conclusions. malignant glaucoma is a rare complication following DMEK. Corneal clearance can be attained despite graft detachment after DMEK probably due to an unintentional Descemet Membrane Endothelial Transfer (DMET). However, in low dosage, steroid treatment remains a risk factor for developing ICK. Abbreviations: PBK = Pseudophakic Bullous Keratopathy, DMEK = Descemet Membrane Endothelial Keratoplasty, DMET = Descemet Membrane Endothelial Transfer, IOP = Intraocular Pressure, BCVA = Best Corrected Visual Acuity, AC = Anterior Chamber, MG = Malignant Glaucoma, ICK = Infectious Crystalline Keratopathy.


Assuntos
Doenças da Córnea/cirurgia , Ceratoplastia Endotelial com Remoção da Lâmina Limitante Posterior/efeitos adversos , Glaucoma/etiologia , Pressão Intraocular/fisiologia , Complicações Pós-Operatórias , Pseudofacia/complicações , Acuidade Visual , Idoso de 80 Anos ou mais , Doenças da Córnea/complicações , Doenças da Córnea/diagnóstico , Feminino , Glaucoma/diagnóstico , Glaucoma/fisiopatologia , Humanos , Pseudofacia/cirurgia
11.
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
13.
Curr Opin Ophthalmol ; 30(6): 484-490, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31589185

RESUMO

PURPOSE OF REVIEW: As humans spend a considerable portion of life in the horizontal position, it is vital to better understand the effect of sleep position on glaucoma. RECENT FINDINGS: The mean positional increase from the supine position to the lateral decubitus position (LDP) in recent literature is less than 2 mmHg for each eye in its dependent position and less than 1 mmHg in the nondependent position. The right LDP is most commonly favored sleeping position. Some evidence suggests that the positional increases persist and so could lead to worse glaucomatous progression in the dependent eye. However, multiple studies failed to find a strong association. Ideally future research will identify risk factors for higher positional increases to identify patients who may benefit from a change in sleep position. To date, medications and argon laser trabeculoplasty have been ineffective in blunting the positional increase, although glaucoma surgery does reduce it. Raising the head of the bed has been linked with blunting the increase as well. SUMMARY: Certain sleeping positions appear to be associated with higher intraocular pressure, although the association between sleep position and glaucoma progression is not as clear.


Assuntos
Glaucoma/diagnóstico , Postura/fisiologia , Sono/fisiologia , Progressão da Doença , Glaucoma/fisiopatologia , Humanos , Pressão Intraocular/fisiologia , Tonometria Ocular
14.
Turk J Ophthalmol ; 49(5): 283-293, 2019 Oct 24.
Artigo em Inglês | MEDLINE | ID: mdl-31650812

RESUMO

Children comprise a unique population of patients in regard to the diagnostic and therapeutic approach of uveitic glaucoma. The management of glaucoma secondary to uveitis in children is extremely challenging and presents various difficulties, which are associated both with the underlying uveitis and the young age of the patients. The treatment of uveitic glaucoma calls for a thorough and individualized approach, involving both pharmacotherapeutic and surgical modalities. It appears that the efficient control of inflammatory activity plays a significant role in the final visual outcome of these patients. This study aims to review the current literature about the management of uveitic glaucoma in pediatric patients.


Assuntos
Anti-Hipertensivos/uso terapêutico , Gerenciamento Clínico , Cirurgia Filtrante/métodos , Glaucoma/terapia , Pressão Intraocular/fisiologia , Uveíte/complicações , Criança , Glaucoma/etiologia , Glaucoma/fisiopatologia , Humanos
15.
Exp Eye Res ; 189: 107833, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31618613

RESUMO

Glaucoma is a multifactorial disease in which retinal ganglion cells (RGCs) undergo excitotoxic damage, leading to their degeneration. The α2-adrenoceptor (α2-AR) agonist brimonidine exerts a neuroprotective effect by regulating postsynaptic excitatory N-methyl-D-aspartate (NMDA) receptor activity in RGCs. However, researchers have not clearly determined whether or how brimonidine regulates inhibitory synaptic transmission in rat models of chronic glaucoma. Whole-cell voltage-clamp and current-clamp recordings were performed in ON- and OFF-type RGCs in retinal slices. Brimonidine directly and acutely enhanced γ-aminobutyric acidergic (GABAergic) transmission mediated by ionotropic GABAA receptors in ON- and OFF-type RGCs in rat retinal slices; this effect occurred at the synaptic terminals and was independent of action potentials and multi-synaptic connections. The highly selective α2-AR antagonist yohimbine blocked the effects of brimonidine. Regarding the postsynaptic GABA receptor sensitivity, brimonidine also increased the amplitude of the GABA-induced current. Additionally, compared to RGCs from the control group, the frequencies and amplitudes of spontaneous excitatory postsynaptic currents (sEPSCs) and miniature excitatory postsynaptic currents (mEPSCs) did not change after brimonidine gravity perfusion. Brimonidine significantly decreased the spontaneous firing frequency of rat RGCs with intact synaptic inputs and decreased the resting membrane potential of RGCs, changes that were blocked by the highly selective GABAA receptor antagonist SR95531. SR95531 alone increased spontaneous action potentials and the resting membrane potential. Based on these findings, an α2-AR agonist facilitated the frequency of the GABAergic inhibitory postsynaptic currents (IPSCs), directly increased the amplitude of the postsynaptic GABA-induced current (GABA receptor reactivity/sensitivity), suppressed the firing frequency of spontaneous action in RGCs with intact synaptic inputs and decreased the resting membrane potential of RGCs, thus deactivating RGCs from the neural network level and reducing the excitotoxic damage occurring during the pathological process of chronic glaucoma.


Assuntos
Tartarato de Brimonidina/farmacologia , Glaucoma/tratamento farmacológico , Pressão Intraocular/efeitos dos fármacos , Potenciais da Membrana/efeitos dos fármacos , Células Ganglionares da Retina/metabolismo , Agonistas de Receptores Adrenérgicos alfa 2/farmacologia , Animais , Doença Crônica , Modelos Animais de Doenças , Potenciais Pós-Sinápticos Excitadores , Glaucoma/metabolismo , Glaucoma/fisiopatologia , Pressão Intraocular/fisiologia , Masculino , Potenciais da Membrana/fisiologia , Técnicas de Patch-Clamp , Terminações Pré-Sinápticas , Ratos , Ratos Wistar , Células Ganglionares da Retina/efeitos dos fármacos , Células Ganglionares da Retina/patologia , Transmissão Sináptica
16.
Invest Ophthalmol Vis Sci ; 60(13): 4241-4248, 2019 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-31618760

RESUMO

Purpose: To assess the agreement between structural (optical coherence tomography [OCT]) and functional (visual field [VF]) glaucomatous damage with an automated method and deviation/probability maps, and to compare this method to a metric method. Methods: Wide-field spectral-domain OCT scans, including the disc and macula, and 24-2 and 10-2 VFs were obtained from 45 healthy control (H) eyes/individuals, and 53 eyes/patients with 24-2 mean deviation (MD) better than -6 dB diagnosed as "definite glaucoma" (DG) by experts. Abnormal structure-abnormal function (aS-aF) agreement was assessed with an automated topographic (T) method based upon VF pattern deviation and OCT probability maps. Results were compared to a metric (M) method optimized for accuracy, (abnormal 24-2 glaucoma hemifield test [GHT] or pattern standard deviation [PSD], or 10-2 PSD AND abnormal OCT [quadrant]). Results: For the T-method, 47 (88.7%) of the 53 DG eyes showed aS-aF agreement, compared to 2 (4.5%) of the 45 H eyes. The aS-aF agreement for these two H eyes was easily identified as mistaken, and did not replicate on a subsequent test. Without the 10-2, the aS-aF agreement decreased from 47 to 34 (64.2%) of 53 DG eyes. For the M-method, 37 (69.8%) of the 53 DG eyes showed aS-aF agreement, while omitting the 10-2 VF resulted in agreement in only 33 (62.3%) eyes. Conclusions: There is good agreement between structural and functional damage, even in eyes with confirmed early glaucomatous damage, if both 24-2 and 10-2 VFs are obtained, and abnormal locations on the VFs are compared to abnormal regions seen on OCT macular and disc scans. This can be done in an objective, automated fashion. (ClinicalTrials.gov number, NCT02547740.).


Assuntos
Glaucoma/fisiopatologia , Adulto , Idoso , Estudos de Casos e Controles , Feminino , Humanos , Macula Lutea/fisiopatologia , Masculino , Pessoa de Meia-Idade , Disco Óptico/fisiopatologia , Estudos Prospectivos , Testes de Campo Visual , Campos Visuais/fisiologia
17.
Invest Ophthalmol Vis Sci ; 60(13): 4141-4150, 2019 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-31598625

RESUMO

Purpose: To determine the relationship between peripapillary scleral strain change and cumulative differential IOP exposure in nonhuman primates (NHPs) with unilateral chronic ocular hypertension. Methods: Posterior scleral shells from 6 bilaterally normal and 10 unilateral chronic ocular hypertension NHPs were pressurized from 5 to 45 mm Hg, and the resulting full-field, three-dimensional, scleral surface deformations were acquired using laser speckle interferometry. Scleral tensile strain (local tissue deformation) was calculated by analytical differentiation of the displacement field; zero strain was assumed at 5 mm Hg. Maximum principal strain was used to represent the scleral strain, and strains were averaged over a 15°-wide (∼3.6-mm) circumpapillary region adjacent to the ONH. The relative difference in mean strain was calculated between fellow eyes and compared with the differential cumulative IOP exposure within NHPs during the study period. The relationship between the relative difference in scleral strain and the differential cumulative IOP exposure in fellow eyes was assessed using an F test and quadratic regression model. Results: Relative differential scleral tensile strain was significantly associated with differential cumulative IOP exposure in contralateral eyes in the chronic ocular hypertension NHPs, with the bilaterally normal NHPs showing no significant strain difference between fellow eyes. The sclera in the chronic ocular hypertension eyes was more compliant than in their fellow eyes at low levels of differential cumulative IOP exposure, but stiffer at larger differential IOPs (P < 0.0001). Conclusions: These cross-sectional findings suggest that longitudinal IOP-induced changes in scleral mechanical behavior are dependent on the magnitude of differential cumulative IOP exposure.


Assuntos
Pressão Intraocular/fisiologia , Hipertensão Ocular/fisiopatologia , Esclera/fisiologia , Animais , Estudos Transversais , Modelos Animais de Doenças , Glaucoma/fisiopatologia , Primatas , Tonometria Ocular
18.
Invest Ophthalmol Vis Sci ; 60(13): 4097-4108, 2019 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-31574535

RESUMO

Purpose: Investigate a significant, dose-related increase in IOP, leading to glaucomatous damage to the neuroretina and optic nerve following intravitreal (ITV) administration of a bispecific F(ab')2 [anti-VEGF/Angiopoietins [ANGPT]F(ab')2] molecule in adult monkeys. Methods: ITV ocular tolerability and investigation of anti-VEGF/ANGPT F(ab')2 (blocking both ANGPT1 and ANGPT2) was done in monkeys; mechanistic studies were done in neonatal mice. Results: Following the second ITV dose of anti-VEGF/ANGPT F(ab')2, all 1.5- and 4-mg/eye treated monkeys developed elevated IOP, which eventually was associated with optic disc cupping and thinning of the neuroretinal rim. Histopathologic examination showed nonreversible axonal degeneration in the optic nerves of animals administered 1.5 mg/eye and higher that was considered secondary to high IOP. Anti-ANGPT Fab also caused elevated IOP in monkeys, but anti-VEGF Fab did not contribute to the IOP increase. In addition, an anti-ANGPT2-selective antibody did not change IOP. In mice simultaneous blockade of ANGPT1 and ANGPT2 impaired the expansion and formation of Schlemm's canal (SC) vessels, similar to genetic ablation of Angpt1/Angpt2 and their receptor TIE2. As previously reported, blocking ANGPT2 alone did not affect SC formation in mice. Conclusions: Dual inhibition of ANGPT1/ANGPT2, but not ANGPT2 alone, leads to increased IOP and glaucomatous damage in monkeys. This confirms a role for TIE2/ANGPT signaling in the control of IOP in adults, a finding initially identified in transgenic mice. Dual pharmacologic inhibition of ANGPT1/ANGPT2 may affect aqueous drainage and homeostasis in adult monkeys and may be useful in developing novel models of glaucoma.


Assuntos
Angiopoietina-1/antagonistas & inibidores , Angiopoietina-2/antagonistas & inibidores , Humor Aquoso/metabolismo , Glaucoma/fisiopatologia , Transdução de Sinais/fisiologia , Fator A de Crescimento do Endotélio Vascular/antagonistas & inibidores , Angiopoietina-1/fisiologia , Angiopoietina-2/fisiologia , Animais , Anticorpos/farmacologia , Pressão Intraocular , Primatas , Fator A de Crescimento do Endotélio Vascular/fisiologia
19.
Expert Opin Ther Pat ; 29(10): 829-839, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31510806

RESUMO

Introduction: Glaucoma, a leading cause of irreversible blindness worldwide, is commonly diagnosed solely in advanced stages of the disease when important and irreversible losses of visual field have already occurred. The identification of effective biomarkers and methods for diagnostic purposes are main interests of the scientific community. Areas covered: This review presents an overview of the current diagnostic methods used for glaucoma and introduces the areas where new efforts are being done for the identification of more sensitive and specific biomarkers. The review then covers the patent literature of the period 2013-2019 regarding diagnostic approaches and biomarkers of glaucoma and the claimed methods for their qualitative and/or quantitative analysis. Expert opinion: In the absence of treatment, glaucoma can cause blindness in a few years. Early diagnostic tools are urgently needed, as this disease incidence is deemed to rapidly increase in the next decades. The current diagnosis of glaucoma, which is based on specific signs of the disease, such as high intraocular pressure, specific optic nerve head changes and visual field loss, is not enough anymore. Molecular genetics represents the area where most efforts are currently made to improve the early detection and monitoring of the disease progression.


Assuntos
Biomarcadores/metabolismo , Glaucoma/diagnóstico , Biologia Molecular/métodos , Animais , Progressão da Doença , Diagnóstico Precoce , Glaucoma/fisiopatologia , Humanos , Pressão Intraocular/fisiologia , Patentes como Assunto , Testes de Campo Visual
20.
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
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