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1.
Invest Ophthalmol Vis Sci ; 63(5): 26, 2022 05 02.
Artigo em Inglês | MEDLINE | ID: mdl-35604665

RESUMO

Purpose: The purpose of this study was to investigate the ocular and hemodynamic factors contributing to the central visual function in glaucoma patients with myopia. Methods: This study was a prospective observational study, which included 236 eyes of 140 patients with normal-tension glaucoma (NTG), which includes 114 eyes with mild myopia (axial length ≥24 and <26 mm) and 122 eyes with moderate-to-severe myopia (axial length ≥26 mm). Ocular characteristics were axial length and posterior pole profiles, including peripapillary atrophy (PPA) to disc area ratio, disc tilt ratio, disc torsion, and disc-foveal angle. Hemodynamic factors included standard deviation of the mean of qualified normal-to-normal intervals (SDNN) of a heart rate variability (HRV) test and vessel density (VD) parameters from optical coherence tomography angiography (OCTA). The root mean square error was estimated as a measure of the VD fluctuation. Association between ocular characteristics and VD parameters of the OCTA with the central sensitivity of the 10-degree visual field or the presence of central scotoma were analyzed. Results: Deep layer VD of the peripapillary and macular areas showed significant differences between mild and moderate-to-severe myopia (P = 0.034 and P = 0.045, respectively). Structural parameters, especially PPA to disc area ratio, had significant correlation with peripapillary VD parameters in myopic eyes. Lower SDNN value (ß = 0.924, P = 0.011), lower deep VD of the macular area (ß = 0.845, P = 0.001), and greater fluctuation of deep VD in the peripapillary area (ß = 1.517, P = 0.005) were associated with the presence of central scotoma in patients with glaucoma with myopia in multivariate logistic regression analysis. Conclusions: The structural changes by myopia, especially in the peripapillary region, affected VD parameters in myopic eyes. Lower deep VD and greater VD fluctuation in the peripapillary region showed association with central scotoma in patients with glaucoma with myopia, suggesting both structural and vascular changes by myopia may be related to central visual function in glaucoma patients with myopia.


Assuntos
Glaucoma , Miopia , Glaucoma/complicações , Glaucoma/fisiopatologia , Hemodinâmica , Humanos , Pressão Intraocular , Miopia/complicações , Miopia/fisiopatologia , Disco Óptico , Estudos Prospectivos , Escotoma , Tomografia de Coerência Óptica
2.
Invest Ophthalmol Vis Sci ; 63(2): 12, 2022 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-35129590

RESUMO

Due to their similarities in anatomy, physiology, and pharmacology to humans, mice are a valuable model system to study the generation and mechanisms modulating conventional outflow resistance and thus intraocular pressure. In addition, mouse models are critical for understanding the complex nature of conventional outflow homeostasis and dysfunction that results in ocular hypertension. In this review, we describe a set of minimum acceptable standards for developing, characterizing, and utilizing mouse models of open-angle ocular hypertension. We expect that this set of standard practices will increase scientific rigor when using mouse models and will better enable researchers to replicate and build upon previous findings.


Assuntos
Humor Aquoso/fisiologia , Consenso , Glaucoma/metabolismo , Pressão Intraocular/fisiologia , Hipertensão Ocular/metabolismo , Malha Trabecular/metabolismo , Animais , Modelos Animais de Doenças , Glaucoma/fisiopatologia , Camundongos , Hipertensão Ocular/fisiopatologia , Tonometria Ocular
3.
Invest Ophthalmol Vis Sci ; 63(1): 18, 2022 01 03.
Artigo em Inglês | MEDLINE | ID: mdl-35024761

RESUMO

Purpose: Growing evidence suggests that dendrite retraction or degeneration in a subpopulation of the retinal ganglion cells (RGCs) may precede detectable soma abnormalities and RGC death in glaucoma. Visualization of the lamellar structure of the inner plexiform layer (IPL) could advance clinical management and fundamental understanding of glaucoma. We investigated whether visible-light optical coherence tomography (vis-OCT) could detect the difference in the IPL sublayer thicknesses between small cohorts of healthy and glaucomatous subjects. Method: We imaged nine healthy and five glaucomatous subjects with vis-OCT. Four of the healthy subjects were scanned three times each in two separate visits, and five healthy and five glaucoma subjects were scanned three times during a single visit. IPL sublayers were manually segmented using averaged A-line profiles. Results: The mean ages of glaucoma and healthy subjects are 59.6 ± 13.4 and 45.4 ± 14.4 years (P = 0.02.) The visual field mean deviations (MDs) are -26.4 to -7.7 dB in glaucoma patients and -1.6 to 1.1 dB in healthy subjects (P = 0.002). Median coefficients of variation (CVs) of intrasession repeatability for the entire IPL and three sublayers are 3.1%, 5.6%, 6.9%, and 5.6% in healthy subjects and 1.8%, 6.0%, 7.7%, and 6.2% in glaucoma patients, respectively. The mean IPL thicknesses are 36.2 ± 1.5 µm in glaucomatous and 40.1 ± 1.7 µm in healthy eyes (P = 0.003). Conclusions: IPL sublayer analysis revealed that the middle sublayer could be responsible for the majority of IPL thinning in glaucoma. Vis-OCT quantified IPL sublayers with good repeatability in both glaucoma and healthy subjects.


Assuntos
Glaucoma/diagnóstico , Pressão Intraocular/fisiologia , Células Ganglionares da Retina/patologia , Tomografia de Coerência Óptica/métodos , Campos Visuais/fisiologia , Adulto , Idoso , Feminino , Glaucoma/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Fibras Nervosas/patologia , Curva ROC
4.
Invest Ophthalmol Vis Sci ; 63(1): 36, 2022 01 03.
Artigo em Inglês | MEDLINE | ID: mdl-35084432

RESUMO

Purpose: Glaucoma is associated with progressive loss of retinal ganglion cells. Here we investigated the impact of glaucomatous damage on monocular and binocular crowding in parafoveal vision. We also examined the binocular summation of crowding to see if crowding is alleviated under binocular viewing. Methods: The study design included 40 individuals with glaucoma and 24 age-similar normal cohorts. For each subject, the magnitude of crowding was determined by the extent of crowding zone. Crowding zone measurements were made binocularly in parafoveal vision (i.e., at 2° and 4° retinal eccentricities) visual field. For a subgroup of glaucoma subjects (n = 17), crowding zone was also measured monocularly for each eye. Results: Our results showed that, compared with normal cohorts, individuals with glaucoma exhibited significantly larger crowding-enlargement of crowding zone (an increase by 21%; P < 0.01). Moreover, we also observed a lack of binocular summation (i.e., a binocular ratio of 1): binocular crowding was determined by the better eye. Hence, our results did not provide evidence supporting binocular summation of crowding in glaucomatous vision. Conclusions: Our findings show that crowding is exacerbated in parafoveal vision in glaucoma and binocularly asymmetric glaucoma seems to induce binocularly asymmetric crowding. Furthermore, the lack of binocular summation for crowding observed in glaucomatous vision combined with the lack of binocular summation reported in a previous study on normal healthy vision support the view that crowding may start in the early stages of visual processing, at least before the process of binocular integration takes place.


Assuntos
Glaucoma/fisiopatologia , Células Ganglionares da Retina/fisiologia , Visão Binocular/fisiologia , Acuidade Visual , Sensibilidades de Contraste/fisiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estimulação Luminosa
5.
Invest Ophthalmol Vis Sci ; 63(1): 40, 2022 01 03.
Artigo em Inglês | MEDLINE | ID: mdl-35089330

RESUMO

Purpose: The purpose of this study was to investigate the association between intraocular pressure (IOP) and ocular geometry. Methods: The Gutenberg Health Study is a population-based cohort study in Mainz, Germany. Study participants underwent a comprehensive ophthalmologic examination including noncontact tonometry, objective refraction, optical biometry, and Scheimpflug imaging of the anterior segment at the first 5-year follow-up examination (in 2012-2017). Multivariable linear regression analysis was carried out to determine associations of IOP and geometric parameter of the human phakic eye, namely central corneal thickness (CCT), corneal curvature, anterior chamber depth (ACD), lens thickness, and axial length. In addition, the relationship of IOP and the anterior chamber angle (ACA) width was analyzed. Results: There were 6640 participants with phakia (age 57.3 ± 10.2 years, 49.1% women) that were included in this cross-sectional analysis. Mean IOP was 14.8 ± 2.9 mm Hg in the right eyes and 14.9 ± 2.9 mm Hg in the left eyes. IOP increased with higher CCT, greater posterior segment length, higher age (all P < 0.001), thicker lens (P = 0.003), and female sex (P = 0.05), whereas the ACD was not associated with higher IOP. The IOP increased with a narrower ACA in univariable analysis (P < 0.001), but not in adjusted analysis in subjects with an open angle. Conclusions: IOP values are related to ocular geometry, as shown in this population-based study on Caucasian subjects. Thus, knowledge of the architecture of the eye is an important factor when measuring IOP. Longitudinal evaluation will analyze whether some of these parameters are also risk factors for the development of glaucoma.


Assuntos
Câmara Anterior/fisiopatologia , Comprimento Axial do Olho/fisiopatologia , Glaucoma/fisiopatologia , Pressão Intraocular/fisiologia , Acuidade Visual , Comprimento Axial do Olho/diagnóstico por imagem , Estudos Transversais , Feminino , Alemanha/epidemiologia , Glaucoma/diagnóstico por imagem , Glaucoma/epidemiologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
6.
Invest Ophthalmol Vis Sci ; 63(1): 10, 2022 01 03.
Artigo em Inglês | MEDLINE | ID: mdl-34994770

RESUMO

Purpose: There is conflicting evidence regarding whether a loss of radial peripapillary capillaries (RPCs) precedes neuronal loss in glaucoma. We examined the time course of in vivo changes in RPCs, optic nerve head (ONH) structure, and retinal nerve fiber layer thickness (RNFLT) in experimental glaucoma (EG). Methods: Spectral domain optical coherence tomography images were acquired before and approximately every two weeks after inducing unilateral EG in nine rhesus monkeys to quantify mean anterior lamina cribrosa surface depth (ALCSD), minimum rim width (MRW), and RNFLT. Perfused RPC density was measured from adaptive optics scanning laser ophthalmoscope images acquired on the temporal half of the ONH. The time of first significant change was quantified as when values fell and remained outside of the 95% confidence interval established from control eyes. Results: Mean ALCSD and/or MRW were the first parameters to change in eight EG eyes. RPC density changed first in the ninth. At their first points of change, mean ALCSD posteriorly deformed by 100.2 ± 101.2 µm, MRW thinned by 82.3 ± 65.9 µm, RNFLT decreased by 25 ± 14 µm, and RPC density decreased by 4.5 ± 2.1%. RPC density decreased before RNFL thinning in 5 EG eyes. RNFLT decreased before RPC density decreased in two EG eyes, whereas two EG eyes had simultaneous changes. Conclusions: In most EG eyes, RPC density decreased before (or simultaneous with) a change in RNFLT, suggesting that vascular factors may play a role in axonal loss in some eyes in early glaucoma.


Assuntos
Modelos Animais de Doenças , Glaucoma/fisiopatologia , Fibras Nervosas/patologia , Disco Óptico/irrigação sanguínea , Células Ganglionares da Retina/patologia , Vasos Retinianos/fisiologia , Animais , Capilares/fisiologia , Feminino , Seguimentos , Pressão Intraocular , Macaca mulatta , Masculino , Oftalmoscopia , Fatores de Tempo , Tomografia de Coerência Óptica
7.
Cornea ; 41(3): 310-316, 2022 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-34133397

RESUMO

PURPOSE: Managing glaucoma after Boston type 1 keratoprosthesis (KPro) surgery remains challenging. We herein assessed the fitness of commonly used clinical tests to evaluate glaucoma in KPro eyes versus eyes with penetrating keratoplasty (PK) as controls. METHODS: Sixteen patients with KPro and 14 patients with PK tested in an identical manner. After the 10-2 visual field with size V stimulus, intraocular pressure (IOP) was estimated with palpation by the first observer. Then, retinal nerve fiber layer (RNFL) thickness analysis was performed twice using optical coherence tomography by an ophthalmic photographer, before and after a short break. After the second observer estimated the IOP, the visual field was repeated. Finally, color photographs of the optic disk were captured by an ophthalmic photographer. The cup-to-disk ratio was assessed by 2 masked observers, at 2 different time points, in a random manner. Agreements between and within observers and reliability of repeated measurements were evaluated using the intraclass correlation coefficient (ICC) and Bland-Altman plots. RESULTS: Inter-rater agreement of palpation IOP estimate was moderate for eyes with KPro (ICC = 0.47) and fair for eyes with PK (ICC = 0.27). Visual field and RNFL thickness showed high test-retest reliability in both KPro and PK eyes (ICC > 0.80 for both). Inter-rater agreement of cup-to-disk ratio assessments was substantial in eyes with both KPro (ICC = 0.62) and PK (ICC = 0.70). CONCLUSIONS: The 10-2 visual field and RNFL thickness seem sufficiently repeatable and might allow the detection of glaucoma progression in KPro eyes. Such testing is important, given limited inter-rater agreement regarding the palpation IOP estimate.


Assuntos
Órgãos Artificiais , Córnea/cirurgia , Glaucoma/cirurgia , Pressão Intraocular/fisiologia , Próteses e Implantes , Implantação de Prótese/métodos , Acuidade Visual , Idoso , Feminino , Seguimentos , Glaucoma/diagnóstico , Glaucoma/fisiopatologia , Humanos , Ceratoplastia Penetrante/métodos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Desenho de Prótese , Reprodutibilidade dos Testes , Tomografia de Coerência Óptica/métodos
8.
Acta Ophthalmol ; 100(1): e29-e37, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33942540

RESUMO

The formation of filtration blebs is the main drainage mechanism for reducing intraocular pressure after traditional incisional glaucoma surgery such as trabeculectomy and non-penetrating deep sclerotomy. Early and short-lasting blebs may also occur after canaloplasty. Bleb formation also plays an important role after the implantation of glaucoma drainage devices, including Minimally Invasive Glaucoma Surgery devices. Anterior segment optical coherence tomography (AS-OCT) is a rapid and non-invasive high-resolution imaging technique that has evolved in recent years to become a routine examination. Anterior segment optical coherence tomography (AS-OCT) provides key information in the assessment and follow-up of glaucoma surgery, especially in the assessment of filtration blebs. Thus, bleb morphology can be qualitatively classified into diffuse, cystic, encapsulated and flattened, and AS-OCT imaging can also provide several quantitative parameters of the bleb, such as total bleb height, bleb fluid-filled cavity height, bleb wall thickness, number of microcysts and trabeculectomy opening size. These parameters could have an impact on clinical management during follow-up because they may predict the success or failure of the surgery in the early and late postoperative periods. Additionally, they may also guide the procedures used to increase filtration and reduce intraocular pressure, such as bleb needling and laser suture lysis.


Assuntos
Segmento Anterior do Olho/diagnóstico por imagem , Implantes para Drenagem de Glaucoma/efeitos adversos , Glaucoma/cirurgia , Complicações Pós-Operatórias/diagnóstico , Tomografia de Coerência Óptica/estatística & dados numéricos , Trabeculectomia/efeitos adversos , Glaucoma/fisiopatologia , Humanos , Pressão Intraocular
9.
Acta Ophthalmol ; 100(1): e246-e252, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33998179

RESUMO

PURPOSE: The aim of this study was to compare outcome of 3 different surgical modalities for management of uveitic glaucoma (UG). METHODS: This is a prospective comparative study, carried out on a cohort of 105 eyes (105 patients) with UG of different aetiologies. Patients were randomly allocated to group A (trabeculectomy), group B (Ahmed glaucoma valve; AGV) or group C (Trans-scleral diode laser cyclophotocoagulation, TDLC). Postoperatively, all patients were followed up for 2 years. Humphrey SITA standard perimetry was done 6, 12 and 24 months. Complete success was defined as IOP ≤ 21 mmHg and relative decrease of ≥20%, without additional glaucoma surgery or antiglaucoma medication, qualified success as IOP ≤ 21 mmHg and additional reduction of ≥20% in IOP, without additional glaucoma surgery, but with topical medications, while failure was considered when IOP was not controlled with topical medications and the patient needed additional surgery, or hypotony for ≥2 months. RESULTS: At first, IOP was significantly lower with AGV and significantly higher with TDLC, with significant drop and percentage drop between the three groups. Starting from the 6th month postoperatively till the end of the 2-year period, there was no statistically significant difference between the 3 groups. There was no significant difference between the three groups, with complete success achieved in 60% with trabeculectomy, 68.6% with AGV and 62.9% with TDLC. There was significant difference for inflammatory cells grading; 65.7% of eyes with trabeculectomy had 2+ cells, 57% with AGV had 0 cells while 45.7% with TDLC had 1+ cells. CONCLUSION: The three surgical modalities had the same IOP-lowering effect on the long run, with complete success rate that is close enough between them, with AGV revealing the least inflammation, which might be the cause of more stable VF with Ahmed's valve proving its superiority to the other 2 techniques for inflammatory glaucoma.


Assuntos
Gerenciamento Clínico , Implantes para Drenagem de Glaucoma , Glaucoma/cirurgia , Pressão Intraocular/fisiologia , Trabeculectomia/métodos , Uveíte/complicações , Acuidade Visual , Adolescente , Adulto , Feminino , Seguimentos , Glaucoma/etiologia , Glaucoma/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
10.
Curr Eye Res ; 47(1): 69-78, 2022 01.
Artigo em Inglês | MEDLINE | ID: mdl-34252337

RESUMO

PURPOSE/AIM OF THE STUDY: Researchers have investigated glaucoma drainage devices in various in vitro experimental setups to overcome their disadvantages. In this study, it is aimed to perform in vitro analyses of glaucoma drainage devices that are actively utilized for glaucoma treatment. MATERIALS AND METHODS: A new in vitro experimental setup is constructed and the first outcomes of numerical simulations and experimental trials are shared. Firstly, an in vitro experimental setup is designed and simulated in ANSYS Fluent, then assembled/fabricated using microfluidic equipment. Secondly, computational fluid dynamics results are expressed as pressure losses through an Ahmed Valve implant, a Molteno drainage device, an Ex-Press implant for physiological flow rates. RESULTS: In the scope of this study, Ahmed Valve (valved), Molteno (non-valved), Ex-Press (orbital shunt) implants are examined numerically using computational fluid dynamics tools. Results are compared with in vitro studies of the proposed experimental setup. Poiseuille and Reynolds numbers versus pressure drop characteristics of tested glaucoma drainage devices are also obtained using in vitro microfluidic experimental setup. In the range of 1.6-2.5 µl/min, Ahmed Valve implant created an active and effective pressure drop of 5.6 to 12 mmHg. Ahmed Valve and Molteno showed similar characteristics in terms of Poiseuille and Reynolds numbers variations with pressure drop across implants. Ex-Press, opposing Molteno and Ahmed Valve gave a reciprocal correlation between pressure drop and Po. CONCLUSIONS: High resemblances of pressure drops between computational fluid dynamics results and in vitro microfluidic experimental results proved that the setup will be a better choice compared to syringe pump type setups for testing different glaucoma drainage devices at the same conditions. In conclusion, a new glaucoma drainage device should be equipped with a slimmer but larger end plate and a valve mechanism similar to Ahmed Valve in the perspective of intraocular pressure drop performance.


Assuntos
Implantes para Drenagem de Glaucoma , Glaucoma/cirurgia , Pressão Intraocular/fisiologia , Microfluídica/métodos , Modelos Biológicos , Seguimentos , Glaucoma/fisiopatologia , Humanos , Tonometria Ocular
11.
Acta Ophthalmol ; 100(2): e463-e469, 2022 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-34328703

RESUMO

PURPOSE: This study explores the effect of glaucomatous visual field defects on several neuropsychological tests that are often used in research and in clinical settings. METHODS: Nineteen glaucoma patients and nineteen healthy participants, which are current drivers and older than 65 years old were included. All participants completed the Montreal Cognitive Assessment (MoCA), the Trail Making Test (TMT), the Benton Visual Retention Test (BVRT), the Snellgrove Maze Task (SMT) and the Digit Span Test (DST). All participants were also tested on contrast sensitivity and near and far visual acuity. For the glaucoma patients, visual field tests were downloaded from hospital servers. RESULTS: On the MoCA test, glaucoma patients scored lower than the healthy group, but not significantly. On the MoCA-Blind, the difference was statistically significant. Glaucoma patients also had lower percentile scores on the TMT, with a significant difference in the TMT-A, but this difference largely disappeared in the calculated TMT B-A index, which isolates the cognitive component. The BVRT and SMT showed no significant differences between both groups. In the only non-visual test, the DST, glaucoma patients outperformed the healthy group. Glaucoma severity did not influence results, except for the BVRT on which the moderate/severe group has better scores. CONCLUSION: Using visual items might lead to conclusions about cognition when it should be one about vision. Therefore, careful selection of tests is needed when examining cognition in glaucoma patients.


Assuntos
Condução de Veículo/estatística & dados numéricos , Glaucoma/fisiopatologia , Transtornos da Visão/diagnóstico , Idoso , Estudos de Casos e Controles , Disfunção Cognitiva/diagnóstico , Feminino , Humanos , Masculino , Testes Neuropsicológicos , Índice de Gravidade de Doença
12.
Ophthalmol Glaucoma ; 5(3): 313-324, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-34655797

RESUMO

PURPOSE: Information regarding the views of patients, on visual field testing is limited, and no information exists regarding their preferences for test developments. This study aimed to increase knowledge of patients' experiences of visual field assessment and to explore their opinions and priorities regarding current areas of research and development. DESIGN: Online questionnaire with purposive sampling design. PARTICIPANTS: Adults who regularly undergo visual field tests in Australia who report having glaucoma or being at glaucomatous risk. METHODS: An anonymous survey, implemented using the Qualtrics webtool, with both closed- and-open ended questions designed to explore opinions regarding visual field testing, visit attendance for perimetry, as well as priorities for developments. MAIN OUTCOME MEASURES: The survey assessed 3 domains: (1) opinions regarding test duration and visit frequency, (2) subjective experience, and (3) perspectives on future developments. RESULTS: One hundred fifty-two complete survey responses were obtained. The median age of participants was 66 years (interquartile range [IQR], 60-72 years). Most participants (70%) had experience of undergoing more than 11 visual field tests. Participants recalled that they completed visual field tests in median of 6 minutes (IQR, 5-8 minutes) and were willing to accept additional time (median, 5 minutes; IQR, 3-6 minutes) to obtain more information. Participants were prepared to increase both the number of visual field tests per eye and the frequency of visual field tests (median, 3 visits per year; IQR, 2-4 visits per year) to gain more information about their visual status. Regarding future developments, the most preferred option was "similar test times but an increase in the level of information about my visual field," which ranked significantly higher than all other options, including "shorter test times that maintain the currently available level of information about my visual field." CONCLUSIONS: Our study confirms, in a different population and health care system, previous research reporting patient perspectives on visual field assessment. We further revealed that health care consumers show a strong preference for accurate information about their vision and report being prepared to undergo longer visual field tests or more visual field tests to achieve that outcome.


Assuntos
Glaucoma , Preferência do Paciente , Testes de Campo Visual , Idoso , Austrália , Glaucoma/diagnóstico , Glaucoma/fisiopatologia , Humanos , Pessoa de Meia-Idade , Pesquisa , Inquéritos e Questionários , Campos Visuais/fisiologia
13.
Ophthalmology ; 129(2): 161-170, 2022 02.
Artigo em Inglês | MEDLINE | ID: mdl-34474070

RESUMO

PURPOSE: To investigate the effect of systemic arterial blood pressure (BP) on rates of progressive structural damage over time in glaucoma. DESIGN: Retrospective cohort study. PARTICIPANTS: A total of 7501 eyes of 3976 subjects with glaucoma or suspected of glaucoma followed over time from the Duke Glaucoma Registry. METHODS: Linear mixed models were used to investigate the effects of BP on the rates of retinal nerve fiber layer (RNFL) loss from spectral-domain OCT (SD-OCT) over time. Models were adjusted for intraocular pressure (IOP), gender, race, diagnosis, central corneal thickness (CCT), follow-up time, and baseline disease severity. MAIN OUTCOME MEASURE: Effect of mean arterial pressure (MAP), systolic arterial pressure (SAP), and diastolic arterial pressure (DAP) on rates of RNFL loss over time. RESULTS: A total of 157 291 BP visits, 45 408 IOP visits, and 30 238 SD-OCT visits were included. Mean rate of RNFL change was -0.70 µm/year (95% confidence interval, -0.72 to -0.67 µm/year). In univariable models, MAP, SAP, and DAP during follow-up were not significantly associated with rates of RNFL loss. However, when adjusted for mean IOP during follow-up, each 10 mmHg reduction in mean MAP (-0.06 µm/year; P = 0.007) and mean DAP (-0.08 µm/year; P < 0.001) but not SAP (-0.01 µm/year; P = 0.355) was associated with significantly faster rates of RNFL thickness change over time. The effect of the arterial pressure metrics remained significant after additional adjustment for baseline age, diagnosis, sex, race, follow-up time, disease severity, and corneal thickness. CONCLUSIONS: When adjusted for IOP, lower MAP and DAP during follow-up were significantly associated with faster rates of RNFL loss, suggesting that levels of systemic BP may be a significant factor in glaucoma progression.


Assuntos
Pressão Sanguínea/fisiologia , Glaucoma/diagnóstico , Glaucoma/fisiopatologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Pressão Arterial/fisiologia , Progressão da Doença , Feminino , Seguimentos , Humanos , Pressão Intraocular/fisiologia , Masculino , Pessoa de Meia-Idade , Fibras Nervosas/patologia , Hipertensão Ocular/fisiopatologia , Sistema de Registros , Células Ganglionares da Retina/patologia , Estudos Retrospectivos , Tomografia de Coerência Óptica , Tonometria Ocular
14.
Rev. bras. oftalmol ; 81: e0036, 2022. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1376779

RESUMO

ABSTRACT The purpose of this study was to highlight the impact of biomechanical corneal response in available in vivo tonometry methods for glaucoma management. Systematic review of non-contact air-puff tonometers that analyzes the corneal deformation response, with special focus on the investigation of the correlation of derived parameters with intraocular pressure measurements. The two actual and commercially available in vivo corneal tonometers provide promising information about biomechanical characteristics of the cornea and its relation to glaucoma, allowing the development of new protocols to evaluate, diagnose, and manage this disease.


RESUMO O objetivo deste estudo é destacar o impacto da resposta biomecânica corneana em métodos de tonometria in vivo disponíveis para o manejo do glaucoma. Trata-se de revisão sistemática de tonômetros de ar que analisa a resposta à deformação corneana, com foco especial na investigação da correlação dos parâmetros derivados com as medições da pressão intraocular. Os dois tonômetros mais recentes e comercialmente disponíveis fornecem informações promissoras sobre as características biomecânicas da córnea e sua relação com o glaucoma, permitindo o desenvolvimento de novos protocolos para avaliar, diagnosticar e controlar a doença.


Assuntos
Humanos , Tonometria Ocular/instrumentação , Tonometria Ocular/métodos , Fenômenos Biomecânicos , Córnea/anatomia & histologia , Córnea/fisiologia , Pressão Intraocular/fisiologia , Glaucoma/fisiopatologia , Hipertensão Ocular/fisiopatologia , Técnicas de Diagnóstico Oftalmológico/instrumentação , Elasticidade/fisiologia , Modelos Teóricos
15.
Rev. bras. oftalmol ; 81: e0041, 2022. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1387975

RESUMO

ABSTRACT Glaucoma drainage devices are important therapeutic options for cases of refractory glaucoma, in which trabeculectomy with antimetabolites has shown high risk of failure. There are devices with different sizes, designs and materials, and several studies have been conducted to test their safety and effectiveness. Despite known complications, their use has progressively increased in recent years, and they are the primary surgical option, in some situations. The aim of this review is to discuss the importance, mechanisms, biomaterials, results and complications of glaucoma drainage devices.


RESUMO Os dispositivos de drenagem para glaucoma são importante opção terapêutica em casos de glaucomas refratários, nos quais a trabeculectomia com antimetabólitos tem alta chance de falência. Há dispositivos com diferentes tamanhos, desenhos e materiais, e muitos estudos foram realizados para testar sua segurança e eficácia. Apesar de suas conhecidas complicações, seu uso tem aumentado progressivamente nos últimos anos, inclusive como primeira opção cirúrgica, em algumas situações. O objetivo desta revisão foi discutir a importância, os mecanismos, os biomateriais, os resultados e as complicações dos dispositivos de drenagem para glaucoma.


Assuntos
Humanos , Glaucoma/cirurgia , Cirurgia Filtrante/instrumentação , Implantes para Drenagem de Glaucoma , Materiais Biocompatíveis , Glaucoma/fisiopatologia , Cirurgia Filtrante/métodos , Implantação de Prótese , Pressão Intraocular/fisiologia
16.
Comput Math Methods Med ; 2021: 6084496, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34873416

RESUMO

With an increasing incidence in recent years, glaucoma (GL) has gradually become a global public health problem for humans of all ages. Nerve growth factor (NGF) eye drops, with well-documented stable effect in the treatment of GL, can be potentiated by the administration of NGF drugs via ultrasound contrast agent (UCA). This study analyzed the efficacy of NGF+UCA on GL mice and the influencing mechanism on retinal ganglion cells and further explored the pathological changes of GL mice under different UCA irradiation duration. In this study, we established GL mouse models and treated the mouse with NGF+UCA. The effect of NGF+UCA on intraocular pressure in mice was observed; the flash visual evoked potential of mice was compared; the changes of retinal structure, inflammation index, and oxidative stress index were observed, and autophagic protein levels were tested. Finally, the influence of UCA irradiation duration on GL symptoms was observed. The results showed that the intraocular pressure of mice decreased greatly, while their flash visual evoked potential and nervous layer of retina increased, and their ganglion cells showed stronger proliferation activity and weaker apoptosis and autophagy, indicating that UCA-mediated NGF can strongly improve the pathological condition of GL mice. In addition, PI3K/AKT pathway-associated proteins were inhibited in retina under the intervention of NGF+UCA, which further suggests that the influence of UCA-mediated NGF on GL is achieved by inhibiting autophagy of retinal ganglion cells and enhancing their apoptosis via the PI3K/AKT signaling pathway. Moreover, we found that in the treatment of GL, three weeks of UCA irradiation and six weeks caused no significant difference in the pathological manifestations and ganglion cells of mice, while after six weeks of irradiation, the level of NLRP3 in mice increased. In conclusion, UCA-mediated NGF can significantly improve the pathological condition of GL mice and improve the apoptosis of retinal ganglion cells by inhibiting autophagy, which is associated with the inhibition of the PI3K/AKT signal pathway. In terms of selection of UCA irradiation duration, three weeks of irradiation is enough to yield good clinical results.


Assuntos
Glaucoma/terapia , Fator de Crescimento Neural/administração & dosagem , Células Ganglionares da Retina/efeitos dos fármacos , Animais , Apoptose/efeitos dos fármacos , Proliferação de Células/efeitos dos fármacos , Biologia Computacional , Meios de Contraste/administração & dosagem , Modelos Animais de Doenças , Glaucoma/patologia , Glaucoma/fisiopatologia , Mediadores da Inflamação/metabolismo , Pressão Intraocular/efeitos dos fármacos , Camundongos , Camundongos Endogâmicos C57BL , Soluções Oftálmicas , Estresse Oxidativo/efeitos dos fármacos , Fosfatidilinositol 3-Quinases/metabolismo , Proteínas Proto-Oncogênicas c-akt/metabolismo , Células Ganglionares da Retina/patologia , Células Ganglionares da Retina/fisiologia , Transdução de Sinais/efeitos dos fármacos , Terapia por Ultrassom
17.
Sci Rep ; 11(1): 22879, 2021 11 24.
Artigo em Inglês | MEDLINE | ID: mdl-34819533

RESUMO

It has been previously demonstrated that the adaptive phase changes of steady-state pattern electroretinogram (SS-PERG), recorded during 4-min presentation of patterned stimuli, are reduced in glaucoma suspects and patients compared to normal subjects. Our study aims at testing the hypothesis that adaptive changes of SS-PERG, recorded using the novel optimized Next Generation PERG (PERGx) protocol, differ between glaucoma patients and controls. In this pilot cross-sectional study, we included 28 glaucoma patients and 17 age-matched normal subjects. Both patients and controls underwent a full ophthalmologic examination, visual field testing, OCT and PERGx. The PERGx signal was sampled over 2 min (providing 1 noise and 9 signal packets) in response to alternating gratings generated on an OLED display. PERGx amplitude and phase were analyzed to quantify adaptive changes over recording time. Receiver operating characteristic (ROC) curves were used to study the diagnostic accuracy of PERGx parameters in distinguishing glaucoma patients from normal subjects. PERGx amplitude and phase data showed declining trends in both groups. PERGx amplitude slope and grand-average vector amplitude and phase were significantly different in patients compared to controls (p < 0.01), whereas phase angular dispersion was greater in patients but not significantly different between the two groups. The area under the ROC curves were 0.87 and 0.76 for PERGx amplitude slope and grand-average vector amplitude, and 0.62 and 0.87 for PERGx angular dispersion and grand-average vector phase, respectively. The PERGx paradigm resulted highly accurate in detecting the reduction of amplitude adaptive changes in glaucoma patients, presumably due to the loss of functional retinal ganglion cell autoregulation. Thus, PERG adaptation, recorded by this new protocol, might be helpful in the identification and diagnosis of early glaucomatous dysfunction.


Assuntos
Eletrorretinografia , Glaucoma/diagnóstico , Fenômenos Fisiológicos Oculares , Células Ganglionares da Retina/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Estudos Transversais , Diagnóstico Precoce , Feminino , Glaucoma/patologia , Glaucoma/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Estimulação Luminosa , Projetos Piloto , Valor Preditivo dos Testes , Processamento de Sinais Assistido por Computador
18.
Sci Rep ; 11(1): 22880, 2021 11 24.
Artigo em Inglês | MEDLINE | ID: mdl-34819548

RESUMO

Glaucoma is a chronic and progressive neurodegenerative disease of the optic nerve resulting in loss of retinal ganglion cells (RGCs) and vision. The most prominent glaucoma risk factor is increased intraocular pressure (IOP), and most models focus on reproducing this aspect to study disease mechanisms and targets. Yet, current models result in IOP profiles that often do not resemble clinical glaucoma. Here we introduce a new model that results in a gradual and sustained IOP increase over time. This approach modifies a circumlimbal suture method, taking care to make the sutures 'snug' instead of tight, without inducing an initial IOP spike. This approach did not immediately affect IOPs, but generated gradual ocular hypertension (gOHT) as the sutures tighten over time, in comparison to loosely sutured control eyes (CON), resulting in an average 12.6 mmHg increase in IOP at 17 weeks (p < 0.001). Corresponding characterization revealed relevant retinal and optic nerve pathology, such as thinning of the retinal nerve fiber layer, decreased optokinetic response, RGC loss, and optic nerve head remodeling. Yet, angles remained open, with no evidence of inflammation. Corresponding biochemical profiling indicated significant increases in TGF-ß2 and 3, and IL-1 family cytokines in gOHT optic nerve tissues compared to CON, with accompanying microglial reactivity, consistent with active tissue injury and repair mechanisms. Remarkably, this signature was absent from optic nerves following acute ocular hypertension (aOHT) associated with intentionally tightened sutures, although the resulting RGC loss was similar in both methods. These results suggest that the pattern of IOP change has an important impact on underlying pathophysiology.


Assuntos
Glaucoma/fisiopatologia , Pressão Intraocular , Nervo Óptico/fisiopatologia , Retina/fisiopatologia , Técnicas de Sutura , Animais , Modelos Animais de Doenças , Progressão da Doença , Glaucoma/etiologia , Glaucoma/metabolismo , Glaucoma/patologia , Mediadores da Inflamação/metabolismo , Interleucina-1/metabolismo , /metabolismo , Nervo Óptico/metabolismo , Nervo Óptico/patologia , Ratos Long-Evans , Retina/metabolismo , Retina/patologia , Fatores de Tempo , Fator de Crescimento Transformador beta2/metabolismo , Fator de Crescimento Transformador beta3/metabolismo
19.
Int J Mol Sci ; 22(20)2021 Oct 14.
Artigo em Inglês | MEDLINE | ID: mdl-34681739

RESUMO

This review focuses on the clinical translation of preclinical studies, especially those that have used stem cells in the treatment of glaucoma, with an emphasis on optic nerve regeneration. The studies referred to in the review aim to treat optic nerve atrophy, while cell therapies targeting other sites in the eye, such as the trabecular meshwork, have not been addressed. Such complex and varied pathophysiological mechanisms that lead to glaucoma may explain the fact that although stem cells have a high capacity of neuronal regeneration, the treatments performed did not have the expected results and the promise offered by animal studies was not achieved. By analyzing the facts associated with failure, important lessons are to be learned: the type of stem cells that are used, the route of administration, the selection of patients eligible for these treatments, additional therapies that support stem cells transplantation and their mode of action, methods of avoiding the host's immune response. Many of these problems could be solved using exosomes (EV), but also miRNA, which allows more targeted approaches with minimal side effects.


Assuntos
Glaucoma/etiologia , Glaucoma/terapia , Células Ganglionares da Retina/patologia , Células-Tronco , Ensaios Clínicos como Assunto , Exossomos , Glaucoma/fisiopatologia , Humanos , MicroRNAs , Regeneração Nervosa , Nervo Óptico/fisiologia , Transplante de Células-Tronco
20.
Invest Ophthalmol Vis Sci ; 62(13): 27, 2021 10 04.
Artigo em Inglês | MEDLINE | ID: mdl-34705024

RESUMO

Purpose: To identify the presence of choroidal microvascular dropout (MvD) in nonarteritic anterior ischemic optic neuropathy (NAION) eyes and to characterize the topographical distribution for the mechanistic interpretation of MvD development. Methods: We performed optical coherence tomography angiography on 47 open-angle glaucoma (OAG) and 19 NAION eyes with ß-zone peripapillary atrophy (ßPPA). We recorded the presence of MvD and compared between the peripapillary topographical measures of MvD, retinal nerve fiber layer (RNFL) defect, and ßPPA in angular width and location. Results: MvD was present in both diseases, marginally more frequently in NAION eyes (19/19, 100.0%) than in OAG eyes (38/47, 80.6%, P = 0.050), without a discernable difference in appearance. NAION eyes also showed wider MvD and RNFL defects compared to OAG eyes (both P < 0.001). In topographical measurements, the distribution of MvD showed a strong correspondence to superimposition areas of ßPPA and RNFL defects, more distinctly than to RNFL defects (all P < 0.001). The outline of superimposition area also remarkably resembled the MvD area. Conclusions: MvD was present in both the OAG and NAION groups. The ßPPA-RNFL defect superimposition area topographically and morphologically matched MvD. Further investigations are needed to elucidate the role of RNFL defects in the pathogenesis of MvD and the clinical significance.


Assuntos
Corioide/irrigação sanguínea , Angiofluoresceinografia/métodos , Glaucoma/diagnóstico , Microvasos/patologia , Neuropatia Óptica Isquêmica/diagnóstico , Vasos Retinianos/patologia , Tomografia de Coerência Óptica/métodos , Estudos Transversais , Feminino , Seguimentos , Fundo de Olho , Glaucoma/complicações , Glaucoma/fisiopatologia , Glaucoma de Ângulo Aberto , Humanos , Pressão Intraocular , Masculino , Pessoa de Meia-Idade , Fibras Nervosas/patologia , Disco Óptico/patologia , Neuropatia Óptica Isquêmica/etiologia , Neuropatia Óptica Isquêmica/fisiopatologia , Células Ganglionares da Retina/patologia , Estudos Retrospectivos , Campos Visuais
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