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1.
Optom Vis Sci ; 97(2): 62-67, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-32011576

RESUMO

SIGNIFICANCE: Optical coherence tomography speckle is used here in an unconventional way as the indirect source of information on tissue microstructure. The study reveals that the corneal speckle of glaucoma suspects has a similar relationship between the parameters of scattering exhibited in glaucoma patients. PURPOSE: The purpose of this study was to evaluate the potential of optical coherence tomography imaging of the cornea in early diagnosis of glaucoma. METHODS: Corneas of 64 subjects of three groups, including 18 primary open-angle glaucoma patients, 24 glaucoma suspects with normal levels of IOP and uncompromised visual field, and 22 age-matched controls, were imaged with spectral optical coherence tomography. A central region of interest in each optical coherence tomography image visualizing the stroma was automatically extracted, and the intensity data within that region were fit with the generalized gamma distribution. Its parameters describe the scatterer cross section and scatterer density and indirectly assess corneal microstructure. In addition, subjects underwent measurements of IOP, visual field, Heidelberg Retinal Tomography, retinal nerve fiber layer thickness, and biometry. Group means of all parameters were tested for equality. Within each group of subjects, correlation was evaluated between the statistical parameters of the corneal speckle. RESULTS: Glaucoma suspects had statistically significantly different IOP, visual field parameters, mean retinal fiber layer thickness, and central corneal thickness from those of glaucoma patients but not from those of the control group. The parameters of the corneal speckle were not significantly different between the groups, but they showed a markedly higher and statistically significant coefficient of determination for glaucoma patients and suspects than that for the control group (0.927 and 0.707 vs. 0.336). CONCLUSIONS: The results indicate that glaucoma suspects have similar relationship between the corneal scatterer cross section and scatterer density to that exhibited in the glaucoma patients but markedly different from that of healthy controls.


Assuntos
Córnea/diagnóstico por imagem , Glaucoma de Ângulo Aberto/diagnóstico , Tomografia de Coerência Óptica/métodos , Adulto , Idoso , Estudos Transversais , Diagnóstico Precoce , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Hipertensão Ocular/diagnóstico
2.
Optom Vis Sci ; 97(2): 86-93, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-32011580

RESUMO

SIGNIFICANCE: Icare HOME rebound tonometry is increasingly adopted into clinical practice for IOP phasing of glaucoma patients and suspects. Because of measurement differences with applanation tonometry and diurnal fluctuations, interpretation of the IOP measured with Icare HOME phasing can be challenging. PURPOSE: The purpose of this study was to use a large patient cohort to develop a practical, analytical tool for interpreting Icare HOME measurements with respect to applanation pressure. METHODS: IOP measurements using the Icare HOME and an applanation tonometer were taken prospectively in 498 consecutive patients. Bland-Altman, frequency distribution, and linear regression analysis were applied to determine measurement differences. A novel criterion, Threshold Icare HOME IOP, was developed to assist identification of elevation above target applanation pressure, considering the expected diurnal variation and measurement variability. RESULTS: Icare HOME tended to underestimate applanation tonometry (mean bias, -1.7 mmHg; 95% limits of agreement, -7.0 to +3.6). Overall, differences were within ±3 mmHg in 71.5% and ±5 mmHg in 92% of patients. Based on the novel criterion developed, Icare HOME measurements that exceed target applanation pressure by 6 mmHg or greater are generally outside the 95% limit of expected observations. CONCLUSIONS: The Threshold Icare HOME IOP is a novel and practical criterion that can assist clinicians in their interpretation of Icare HOME phasing measurements with respect to target applanation pressures. Elevation above the expected thresholds may prompt closer monitoring or even modifications to glaucoma management.


Assuntos
Pressão Intraocular/fisiologia , Hipertensão Ocular/diagnóstico , Autocuidado/métodos , Tonometria Ocular/métodos , Adulto , Idoso , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Monitorização Fisiológica , Hipertensão Ocular/fisiopatologia , Estudos Prospectivos , Reprodutibilidade dos Testes
3.
PLoS One ; 15(2): e0227488, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32012155

RESUMO

People suffering from glaucoma often endure high intra-ocular pressure (IOP). Methods for determining IOP either contact the eye or are unpleasant to some patients. There is therefore a need for a rapid and patient friendly non-contacting method to determine IOP. To address this need, we developed a tonometer prototype that employs spark-gap induced shock waves and a laser Doppler vibrometer (LDV) that reads the amplitude of membrane waves. The IOP was first identified from the membrane wave propagation velocity first in a custom-made ocular phantom and was then verified in ex vivo porcine eyes. The time-of-flight (TOF) of the membrane wave travelling on a hemispherical membrane was compared to reference IOP values in the sample obtained with an iCare TA01 tonometer. The shock front was characterized by high speed photography. Within one eye, the method achieved an agreement of 5 mmHg (1.96 standard deviation between the shock wave tonometer and the commercial manometer) and high method-to-method association (Pearson correlation, R2 = 0.98). The results indicate that the presented method could potentially be developed into a non-contacting technique for measuring IOP in vivo.


Assuntos
Glaucoma/diagnóstico , Fluxometria por Laser-Doppler/métodos , Hipertensão Ocular/diagnóstico , Tonometria Ocular/métodos , Animais , Olho/diagnóstico por imagem , Olho/fisiopatologia , Glaucoma/fisiopatologia , Humanos , Pressão Intraocular/fisiologia , Hipertensão Ocular/fisiopatologia , Fotografação , Estudos Prospectivos , Suínos
4.
PLoS One ; 15(1): e0224824, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31914133

RESUMO

BACKGROUND: To develop a method, using current clinical instrumentation, to estimate the Young's modulus of the human cornea in vivo. METHODS: Central corneal curvature (CCC), central corneal thickness(CCT), intraocular pressure (IOP) was measured with the Goldmann tonometer (IOPG) and the Pascal Dynamic Corneal Tonometer(PDCT) in one eye of 100 normal young human subjects (21.07 ± 2.94 years) in vivo. The Orssengo and Pye algorithm was used to calculate the Young's modulus of the corneas of these subjects. RESULTS: The Young's modulus(E) of the corneas of the subjects using the PDCT and IOPG results (Ecalc) was 0.25 ± 0.10MPa, and without the PDCT results (Eiopg) was 0.29 ± 0.06MPa. The difference in these results is due to the difference in tonometry results between the two instruments, as the mean PDCT result for the subjects was 16.89 ± 2.49mmHg and the IOPG result 15.06 ± 2.71mmHg. E was affected by the CCC of the subjects but more particularly by the CCT and IOP measurements. Corneal stiffness results are also presented. CONCLUSION: Two methods have been developed to estimate the Young's modulus of the human cornea in vivo using current clinical instrumentation. One method (Ecalc) is applicable to the general corneal condition, and Eiopg to the normal cornea, and these results can be used to calculate corneal stiffness.


Assuntos
Córnea/diagnóstico por imagem , Paquimetria Corneana/métodos , Elasticidade/fisiologia , Tonometria Ocular/métodos , Adulto , Algoritmos , Córnea/fisiologia , Doenças da Córnea/diagnóstico , Doenças da Córnea/diagnóstico por imagem , Doenças da Córnea/fisiopatologia , Feminino , Humanos , Pressão Intraocular/fisiologia , Masculino , Hipertensão Ocular/diagnóstico , Hipertensão Ocular/diagnóstico por imagem , Hipertensão Ocular/fisiopatologia
5.
Ophthalmology ; 127(1): 38-44, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31522900

RESUMO

PURPOSE: Ophthalmologic telemedicine has the ability to provide eye care for patients remotely, and many countries have used screening tele-ophthalmology programs for several years. One such initiative at the Veterans Affairs (VA) Healthcare System is Technology-based Eye Care Services (TECS). The TECS services are located in primary care clinics and provide basic screening eye care, including vision, refraction, and retinal photography. Eye care providers ("readers") review the clinical data and recommend appropriate follow-up. One of the most common referrals from TECS has been for glaucoma, and this study was powered for glaucoma/glaucoma suspect detection. The current study was undertaken to identify aspects of the protocol that could be refined to enhance accuracy. DESIGN: Prospective comparison between the standard TECS protocol versus a face-to-face (FTF) examination on 256 patients, all of whom had no known history of significant ocular disease. PARTICIPANTS: Patients with no known ocular disease who were scheduled for an in-person eye appointment at the Atlanta VA. Patients underwent screening through the TECS protocol and received an FTF examination on the same day (gold standard). The TECS readers were masked to the results of the FTF examination. MAIN OUTCOME MEASURES: Percent agreement, kappa, sensitivity, and specificity were calculated for the TECS readers' interpretations versus the FTF examination. RESULTS: The TECS readers showed substantial agreement for cataract (κ ≥ 0.71) and diabetic retinopathy (κ ≥ 0.61) and moderate to substantial agreement for glaucoma/glaucoma suspect (κ ≥ 0.52) compared with an FTF examination. Age-related macular degeneration (AMD) showed moderate agreement (κ ≥ 0.34). Percent agreement with the TECS protocol was high (84.3%-98.4%) for each of the disease categories. Overall sensitivity and specificity were ≥75% and ≥55%, respectively, for any diagnosis resulting in referral. Inter-reader and intra-reader agreement was substantial for most diagnoses (κ > 0.61) with percent agreements ranging from 66% to 99%. CONCLUSIONS: Our results indicate that the standard TECS protocol is accurate when compared with an FTF examination for the detection of common eye diseases. The inclusion of additional testing such as OCT could further enhance diagnostic capability.


Assuntos
Catarata/diagnóstico , Assistência à Saúde/normas , Retinopatia Diabética/diagnóstico , Glaucoma/diagnóstico , Degeneração Macular/diagnóstico , Telemedicina/normas , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Hipertensão Ocular/diagnóstico , Exame Físico/normas , Estudos Prospectivos , Encaminhamento e Consulta , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Veteranos , Acuidade Visual/fisiologia
6.
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 , Avaliação de Resultados em Cuidados de Saúde , Período Pós-Operatório , Estudos Retrospectivos , Tonometria Ocular , Trabeculectomia/métodos
7.
J Glaucoma ; 29(2): 147-153, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31809397

RESUMO

OBJECTIVES: Electrophysiological testing of the visual system has been continuously used in studies involving the evaluation of retinal ganglion cells and the diagnosis of glaucoma. This study aims to review the results of recent studies regarding the clinical applicability of electrophysiological tests to glaucoma. METHODS: A systematic review of the literature was carried out by 2 independent reviewers using the PubMed and EMBASE electronic databases, searching for articles published in English from January 1, 2014 to July 1, 2019 using a combination of the following keywords: ("glaucoma" OR "ocular hypertension") AND ("electrophysiolog" OR "electroretinogra" OR "ERG" OR "mfERG" OR "Pattern-reversal electroretinography" OR "PERG" OR "mfPERG" OR "photopic negative response" OR "pattern electroretinogram" OR "visual evoked potential" OR "multifocal electroretinography" OR "multifocal electroretinogram" OR "electro-oculography" OR "multifocal VEP" OR "mf-ERG"). A total of 38 studies were selected and the data of 30 of them were tabulated in this review. RESULTS: Among the 30 studies selected, the photopic negative response and the reversal pattern electroretinogram were found to be the major methods used to record the electroretinographic responses generated by the retinal ganglion cell. Their multifocal versions and the multifocal visual evoked potential were also proposed during this period. In general, the results underscored a consistent but general correlation between the amplitude and latency measures and routine tests for glaucoma, such as perimetry and optical coherence tomography. DISCUSSION: In agreement with previous reviews, clinical electrophysiological testing of the visual system reasonably matched with both the structural and functional analyses for glaucoma. No definitive indications of these tests have been established either at early detection or during follow-up of the disease, and easier protocols and better topographical correspondence with current glaucoma tests are warranted for their routine use.


Assuntos
Eletrofisiologia/métodos , Potenciais Evocados Visuais/fisiologia , Glaucoma de Ângulo Aberto/diagnóstico , Eletroculografia/métodos , Eletrorretinografia/métodos , Glaucoma de Ângulo Aberto/fisiopatologia , Humanos , Hipertensão Ocular/diagnóstico , Hipertensão Ocular/fisiopatologia , Células Ganglionares da Retina/fisiologia , Tomografia de Coerência Óptica , Testes de Campo Visual/métodos , Campos Visuais/fisiologia
8.
BMC Ophthalmol ; 19(1): 225, 2019 Nov 14.
Artigo em Inglês | MEDLINE | ID: mdl-31726999

RESUMO

BACKGROUND: Measurement of intraocular pressure (IOP) is essential for glaucoma patients. Many factors such as central corneal thickness (CCT) can affect the accuracy of IOP measurement. The purpose of this study was to evaluate the agreement of IOP measured by non-contact tonometer (NCT), iCare pro rebound tonometer (iCare), and Goldmann applanation tonometer (GAT) in different IOP group. METHODS: This was a Hospital-based cross-sectional study. Two hundred subjects were enrolled in this study. All subjects underwent IOP measurement using an NCT-iCare-GAT sequence. Bland-Altman, Pearson correlation and intraclass correlation analysis were performed using SPSS 17.0 software. The influence of CCT on each IOP measurement methods was evaluated by linear regression analysis. RESULTS: The mean difference (Δ) of NCT-GAT did not differ from (Δ) iCare-GAT in IOP < 10 and 10-21 mmHg group. However, (Δ) NCT-GAT was significantly higher than (Δ) iCare-GAT in IOP 22-30 and > 30 mmHg group (P < 0.05). Bland-Altman analysis showed significant agreement between the three devices (P < 0.01). IOP measurements of the three methods were significantly correlated with CCT (P < 0.01). CONCLUSIONS: ICare pro shows a higher agreement with GAT over a wide range of IOP compared with NCT. The consistency between the three tonometers was similar in a low and normal IOP range. However, NCT shows a greater overestimate of IOP in moderate and higher IOP group. The variability of IOP measurement affected by CCT is NCT > iCare pro > GAT.


Assuntos
Pressão Intraocular/fisiologia , Hipertensão Ocular/diagnóstico , Tonometria Ocular/instrumentação , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Glaucoma/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Hipertensão Ocular/fisiopatologia , Análise de Regressão , Reprodutibilidade dos Testes , Adulto Jovem
9.
Invest Ophthalmol Vis Sci ; 60(14): 4548-4555, 2019 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-31675072

RESUMO

Purpose: To determine the association of statins, five classes of antihypertensive medications, and proton pump inhibitors with (1) primary open-angle glaucoma (POAG) progression and (2) conversion of POAG suspects to POAG. Methods: We retrospectively investigated the records of a cohort with POAG cases and suspects from the Groningen Longitudinal Glaucoma Study. To quantify visual field (VF) deterioration in cases, we used the rate of progression of the mean deviation (MD). Suspects were considered to have converted at the time point after which two consecutive VF tests for at least one eye were abnormal (glaucoma hemifield test outside normal limits). Progression and conversion were analyzed with quantile and logistic regression, respectively, with the systemic medications as predictors, controlling for age, sex, body mass index, pretreatment IOP, corneal thickness, and baseline MD. The multivariable models were built with and without IOP intervention. Results: No systemic medications were associated with POAG progression in the final IOP/treatment-adjusted or unadjusted model. However, angiotensin II receptor blockers (ARBs) appeared to slow progression in older patients (b = 0.014, P = 0.0001). Angiotensin-converting enzyme inhibitors (ACEIs) were significantly associated with a decrease in POAG suspect conversion in both the IOP/treatment-adjusted and -unadjusted model (odds ratio [OR] 0.23, 95% confidence interval [CI] 0.07-0.79, P = 0.012; OR=0.24, 95% CI 0.07-0.78, P = 0.021, respectively), as were ARBs (OR 0.12, 95% CI 0.01-0.98, P = 0.014; OR 0.11, 95% CI 0.01-0.87, P = 0.005, respectively). Conclusions: No overall association of VF progression with systemic medication was found; ARBs delayed progression in older patients. ACEIs and ARBs were associated with lower risk of suspect conversion. The pathophysiology of this relationship is to be disentangled.


Assuntos
Anti-Hipertensivos/uso terapêutico , Glaucoma de Ângulo Aberto/diagnóstico , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Idoso , Anti-Hipertensivos/efeitos adversos , Progressão da Doença , Feminino , Alemanha , Glaucoma de Ângulo Aberto/induzido quimicamente , Glaucoma de Ângulo Aberto/fisiopatologia , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/efeitos adversos , Pressão Intraocular/efeitos dos fármacos , Pressão Intraocular/fisiologia , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Nível de Efeito Adverso não Observado , Hipertensão Ocular/induzido quimicamente , Hipertensão Ocular/diagnóstico , Hipertensão Ocular/fisiopatologia , Estudos Retrospectivos , Fatores de Risco , Tonometria Ocular , Transtornos da Visão/induzido quimicamente , Transtornos da Visão/diagnóstico , Testes de Campo Visual , Campos Visuais/efeitos dos fármacos , Campos Visuais/fisiologia
10.
Am J Ophthalmol ; 208: 347-355, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31473215

RESUMO

PURPOSE: To investigate aqueous humor dynamics in uveitic eyes. DESIGN: Cross-sectional study. PARTICIPANTS: Patients with recurrent (≥3 attacks) anterior uveitis (now quiescent) and being treated for glaucoma or ocular hypertension (OHT) (Group 1), previous recurrent anterior uveitis (≥3 attacks) without glaucoma or OHT (Group 2), and normal subjects with no ocular problems and IOP < 21 mm Hg at screening (control group; Group 3). METHODS: Patients had one-off measurements. Group 1 patients who were on antihypertensives were washed out for a 4-week period, prior to their study measurements. Main outcome measures were tonographic outflow facility, aqueous humor flow rate, and uveoscleral outflow. RESULTS: One hundred and one patients were screened between February 2014 and February 2017. Nine patients did not meet the inclusion criteria. Groups 1 and 3 each included 30 patients, and Group 2 included 32 patients. The mean intraocular pressure was higher in Group 1 compared to the others (25 ± 10.2 mm Hg in Group 1 vs 16 ± 2.7 mm Hg in Group 2 vs 16 ± 2.2 mm Hg in Group 3, P < .001). The tonographic outflow facility was lower in Group 1 compared to the others (0.18 ± 0.1 µL/min/mm Hg in Group 1 vs 0.25 ± 0.1 µL/min/mm Hg in Group 2 vs 0.27 ± 0.1 µL/min/mm Hg in Group 3, P = .005). However, aqueous humor flow rate was not statistically different (2.47 ± 0.9 µL/min in Group 1 vs 2.13 ± 0.9 µL/min in Group 2 vs 2.25 ± 0.7 µL/min in Group 3, P = .3). There was also no significant difference in calculated uveoscleral outflow. CONCLUSION: This is the first aqueous humor dynamics study in patients with uveitic glaucoma/OHT and recurrent anterior uveitis compared with age-matched controls. We have demonstrated that the elevated intraocular pressure seen in the uveitic glaucoma/OHT eyes (3-6 attacks) was due to reduced tonographic outflow facility. The aqueous humor flow rate was not detectibly different, nor did the calculated uveoscleral outflow demonstrate any discernible difference. However, the exact mechanism remains to be elucidated.


Assuntos
Humor Aquoso/fisiologia , Glaucoma de Ângulo Aberto/fisiopatologia , Uveíte Anterior/fisiopatologia , Adulto , Anti-Hipertensivos/uso terapêutico , Estudos Transversais , Feminino , Glaucoma de Ângulo Aberto/diagnóstico , Glaucoma de Ângulo Aberto/tratamento farmacológico , Voluntários Saudáveis , Humanos , Pressão Intraocular/fisiologia , Masculino , Pessoa de Meia-Idade , Hipertensão Ocular/diagnóstico , Hipertensão Ocular/tratamento farmacológico , Hipertensão Ocular/fisiopatologia , Tonometria Ocular
11.
Am J Ophthalmol ; 208: 251-264, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31470001

RESUMO

PURPOSE: To compare the visual fields results obtained using the Swedish interactive thresholding algorithm-Standard (SS) and the Swedish interactive thresholding algorithm-Faster (SFR) in normal subjects, glaucoma suspects, and patients with glaucoma and to quantify potential time-saving benefits of the SFR algorithm. DESIGN: Prospective, cross-sectional study. METHODS: One randomly selected eye from 364 patients (77 normal subjects, 178 glaucoma suspects, and 109 patients with glaucoma) seen in a single institution underwent testing using both SS and SFR on the Humphrey Field Analyzer. Cumulative test time using each algorithm was compared after accounting for different rates of test reliability. Pointwise and cluster analysis was performed to determine whether there were systematic differences between algorithms. RESULTS: Using SFR had a greater rate of unreliable results (29.3%) compared with SS (7.7%, P < .0001). This was mainly because of high false positive rates and seeding point errors. However, modeled test times showed that using SFR could obtain a greater number of reliable results within a shorter period of time. SFR resulted in higher sensitivity values (on average 0.5 dB for patients with glaucoma) that was greater under conditions of field loss (<19 dB). Cluster analysis showed no systematic patterns of sensitivity differences between algorithms. CONCLUSIONS: After accounting for different rates of test reliability, SFR can result in significant time savings compared with SS. Clinicians should be cognizant of false positive rates and seeding point errors as common sources of error for SFR. Results between algorithms are not directly interchangeable, especially if there is a visual field deficit <19 dB.


Assuntos
Glaucoma de Ângulo Aberto/diagnóstico , Transtornos da Visão/diagnóstico , Campos Visuais/fisiologia , Adulto , Idoso , Algoritmos , Estudos Transversais , Reações Falso-Positivas , Feminino , Glaucoma de Ângulo Aberto/fisiopatologia , Voluntários Saudáveis , Humanos , Pressão Intraocular/fisiologia , Masculino , Pessoa de Meia-Idade , Hipertensão Ocular/diagnóstico , Hipertensão Ocular/fisiopatologia , Valor Preditivo dos Testes , Probabilidade , Estudos Prospectivos , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Suécia , Transtornos da Visão/fisiopatologia , Testes de Campo Visual
12.
Acta Ophthalmol ; 97(8): e1123-e1129, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31386801

RESUMO

PURPOSE: To evaluate the effect of preoperative intraocular pressure (IOP) and the vacuum level on IOP during femtosecond laser-assisted cataract surgery. METHODS: Intraocular pressure was measured in 40 enucleated porcine eyes by intracameral manometry prior, during and after vacuum application using the VICTUS femtosecond laser platform (Bausch&Lomb, Technolas Perfect Vision GmbH, Germany). Twenty combinations of different preoperative IOP levels (12, 16, 20 and 24 mmHg) and different vacuum levels (350-550 mbar) were investigated. RESULTS: Multivariate regression analysis indicated that both the vacuum level (beta = 0.138; p < 0.001) but much stronger the preoperative IOP (beta = 0.861; p < 0.001) were predictive factors for IOP rise during vacuum application. Mean IOP was 28.23 ± 3.86, 34.23 ± 3.92, 40.35 ± 4.41 and 46.82 ± 4.11 mmHg in groups with baseline IOP of 12, 16, 20 and 24 mmHg, respectively. In the 350, 450 and 550 mbar group, and mean IOP was 35.85 ± 7.85, 37.33 ± 7.90 and 39.00 ± 8.04 mmHg, respectively. Lowering the preoperative IOP by 2 mmHg and reducing the vacuum from maximum to minimum resulted in a similar reduction in IOP during vacuum application (-3.10 ± 0.79 mmHg versus -3.15 ± 0.88 mmHg; p = 0.015). Furthermore, decreasing the baseline IOP from 20 to 12 mmHg resulted in a 30.0% reduction in intraoperative IOP. CONCLUSION: Preoperative IOP was a stronger predictive factor for intraoperative IOP rise than the applied vacuum level. Measurements and critical interpretation of preoperative IOP in a preliminary examination could help estimating the individual risk of significant IOP rise during femtosecond laser-assisted cataract surgery and could help taking early countermeasures in selected cases. Due to the porcine ex vivo model, further studies are needed to verify these findings.


Assuntos
Extração de Catarata/métodos , Pressão Intraocular/fisiologia , Complicações Intraoperatórias/diagnóstico , Terapia a Laser/efeitos adversos , Hipertensão Ocular/diagnóstico , Animais , Modelos Animais de Doenças , Complicações Intraoperatórias/etiologia , Complicações Intraoperatórias/fisiopatologia , Hipertensão Ocular/etiologia , Hipertensão Ocular/fisiopatologia , Valor Preditivo dos Testes , Período Pré-Operatório , Fatores de Risco , Suínos , Tonometria Ocular , Vácuo
13.
Arch. Soc. Esp. Oftalmol ; 94(8): 377-383, ago. 2019. graf
Artigo em Espanhol | IBECS | ID: ibc-185623

RESUMO

Objetivo: Estudiar la presión intraocular postoperatoria (PIOP) elevada tras la intervención de catarata pediátrica en un centro de referencia y comparar los resultados obtenidos con aquellos más relevantes de la literatura mundial. Materiales y métodos: Estudio retrospectivo observacional. Recogida de información de historias clínicas de 99 pacientes (142 ojos) operados de catarata pediátrica unilateral o bilateral entre los años 2000 y 2008. Resultados: La frecuencia de PIOP elevada (≥ 20 mmHg) fue de 79,3% en el grupo de catarata bilateral frente al 20,7% en el grupo de catarata unilateral (p = 0,032). La frecuencia de PIOP elevada entre los ojos con cirugía de catarata antes del mes de edad fue mayor, 50%, que entre los ojos en los que la cirugía de catarata se realizó después del mes de edad, 17,2% (p = 0,009). Los valores de PIOP ≥ 20mmHg se asociaron con una menor agudeza visual mejor corregida a los 5 años de la cirugía de catarata (p = 0,020). La proporción de ojos con PIOP ≥ 20 mmHg y sin lentes intraoculares fue mayor, 69%, que la proporción de ojos con PIOP ≥ 20 mmHg y lentes intraoculares, 31% (p < 0,001). Conclusiones: Un 20,4% del total de ojos estudiados presentaron PIOP elevada ≥ 20 mmHg en un periodo de seguimiento de 5 años, apareciendo con más frecuencia en aquellos con catarata bilateral que unilateral, y en ojos afáquicos que en pseudofáquicos. La elevación de la PIOP se asoció con la realización de la cirugía de la catarata a edades tempranas


Objective: To study elevated postoperative intraocular pressure (PIOP) after paediatric cataract surgery in a reference centre and to compare the results obtained with the most relevant world literature. Materials and methods: A retrospective observational study was conducted, collecting information from clinical records of 99 patients (142 eyes) operated on due to unilateral or bilateral paediatric cataracts between 2000 and 2008. Results: The proportion of eyes with PIOP ≥ 20 mmHg and bilateral cataracts was higher, 79.3%, than the proportion of eyes with PIOP ≥ 20mmHg and a unilateral cataract, 20.7% (P = .032). The proportion of eyes with PIOP ≥ 20 mmHg between the eyes with cataract surgery before one month of age was higher, 50%, than between the eyes in which the cataract surgery was performed after one month of age, 17.2% (P=.009). PIOP values ≥ 20 mmHg were associated with a lower best corrected visual acuity at 5 years after cataract surgery (P = .020). The proportion of eyes with PIOP ≥ 20 mmHg and without intraocular lenses was higher, 69%, than the proportion of eyes with PIOP ≥ 20 mmHg and intraocular lenses, 31% (P < .001). Conclusions: A PIOP > 20 mmHg was observed in 20.4% of eyes in a 5-year follow-up period, appearing more frequently in eyes with bilateral cataract than unilateral, and in aphakic eyes more than pseudophakic eyes. Elevation of the PIOP was associated with the performance of cataract surgery at early ages


Assuntos
Humanos , Recém-Nascido , Lactente , Pré-Escolar , Catarata/congênito , Extração de Catarata/efeitos adversos , Hipertensão Ocular/etiologia , Complicações Pós-Operatórias/etiologia , Fatores Etários , Catarata/patologia , Extração de Catarata/métodos , Extração de Catarata/estatística & dados numéricos , Pressão Intraocular , Implante de Lente Intraocular , Microftalmia/complicações , Hipertensão Ocular/diagnóstico , Estudos Retrospectivos , Acuidade Visual
14.
Acta Ophthalmol ; 97(8): e1112-e1115, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31184426

RESUMO

PURPOSE: To evaluate the apparent intraocular pressure (IOP) change observed after treatment with latanoprost in naive eyes of patients with primary open-angle glaucoma (POAG) or ocular hypertension (OHT) using Goldmann applanation tonometer (GAT), ocular response analyzer (ORA) and Corvis ST tonometry. METHODS: Prospective observational cohort study. One eye from each of 59 newly diagnosed patients with POAG or OHT in our institution was analysed. IOP readings obtained using GAT, ORA and Corvis at baseline and after a 3-month period of treatment with latanoprost were compared. Additionally, pre- and post-treatment biomechanical corneal parameters provided by the Corvis tonometer were analysed. RESULTS: There was no statistically significant difference between the apparent treatment-induced IOP reductions when GAT and ORA were compared (p > 0.05). In contrast, the treatment-induced IOP reduction recorded using the Corvis tonometer was significantly smaller compared to the apparent IOP reduction observed with GAT and ORA (p = 0.0001 for both comparisons). With respect to biomechanical corneal properties, statistically significant changes were found after 3 months of treatment with latanoprost for the first corneal applanation time (AT1) (p = 0.001), second corneal applanation time (AT2) (p = 0.001) and deformation amplitude (DA) (p = 0.0003). CONCLUSION: Following a 3-month course of latanoprost, the apparent treatment-induced IOP reduction in previously naïve patients with POAG or OHT differed depending on the tonometer used. Certain corneal biomechanical parameters assessed using Corvis ST exhibited a significant change. The ocular hypotensive effect of prostaglandin analogues may be overestimated when chronically treated patients are measured using GAT or ORA.


Assuntos
Glaucoma de Ângulo Aberto/tratamento farmacológico , Glaucoma/tratamento farmacológico , Pressão Intraocular/efeitos dos fármacos , Latanoprosta/uso terapêutico , Hipertensão Ocular/tratamento farmacológico , Tonometria Ocular/instrumentação , Adulto , Idoso , Idoso de 80 Anos ou mais , Anti-Hipertensivos/uso terapêutico , Elasticidade , Desenho de Equipamento , Feminino , Seguimentos , Glaucoma/diagnóstico , Glaucoma/fisiopatologia , Glaucoma de Ângulo Aberto/diagnóstico , Glaucoma de Ângulo Aberto/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Hipertensão Ocular/diagnóstico , Hipertensão Ocular/fisiopatologia , Estudos Prospectivos
15.
Arch Soc Esp Oftalmol ; 94(8): 377-383, 2019 Aug.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-31221471

RESUMO

OBJECTIVE: To study elevated postoperative intraocular pressure (PIOP) after paediatric cataract surgery in a reference centre and to compare the results obtained with the most relevant world literature. MATERIALS AND METHODS: A retrospective observational study was conducted, collecting information from clinical records of 99 patients (142 eyes) operated on due to unilateral or bilateral paediatric cataracts between 2000 and 2008. RESULTS: The proportion of eyes with PIOP≥20mmHg and bilateral cataracts was higher, 79.3%, than the proportion of eyes with PIOP≥20mmHg and a unilateral cataract, 20.7% (P=.032). The proportion of eyes with PIOP≥20mmHg between the eyes with cataract surgery before one month of age was higher, 50%, than between the eyes in which the cataract surgery was performed after one month of age, 17.2% (P=.009). PIOP values≥20mmHg were associated with a lower best corrected visual acuity at 5 years after cataract surgery (P=.020). The proportion of eyes with PIOP≥20mmHg and without intraocular lenses was higher, 69%, than the proportion of eyes with PIOP≥20mmHg and intraocular lenses, 31% (P<.001). CONCLUSIONS: A PIOP>20mmHg was observed in 20.4% of eyes in a 5-year follow-up period, appearing more frequently in eyes with bilateral cataract than unilateral, and in aphakic eyes more than pseudophakic eyes. Elevation of the PIOP was associated with the performance of cataract surgery at early ages.


Assuntos
Extração de Catarata/efeitos adversos , Catarata/congênito , Hipertensão Ocular/etiologia , Complicações Pós-Operatórias/etiologia , Fatores Etários , Catarata/patologia , Extração de Catarata/métodos , Extração de Catarata/estatística & dados numéricos , Pré-Escolar , Humanos , Lactente , Recém-Nascido , Pressão Intraocular , Implante de Lente Intraocular , Microftalmia/complicações , Hipertensão Ocular/diagnóstico , Estudos Retrospectivos , Acuidade Visual
16.
Am J Ophthalmol ; 207: 248-257, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31229466

RESUMO

PURPOSE: To compare the ocular hypotensive efficacy and safety of a fixed-dose combination (FDC) of the Rho kinase inhibitor netarsudil and latanoprost vs monotherapy with netarsudil or latanoprost. DESIGN: Three-month primary endpoint analysis of a randomized, double-masked, phase 3 clinical trial. METHODS: Adults with open-angle glaucoma or ocular hypertension (unmedicated intraocular pressure [IOP] >20 and <36 mm Hg at 8:00 AM) were randomized to receive once-daily netarsudil/latanoprost FDC, netarsudil 0.02%, or latanoprost 0.005% for up to 12 months. The primary efficacy endpoint was mean IOP at 8:00 AM, 10:00 AM, and 4:00 PM at week 2, week 6, and month 3. RESULTS: Mean treated IOP ranged from 14.8-16.2 mm Hg for netarsudil/latanoprost FDC, 17.2-19.0 mm Hg for netarsudil, and 16.7-17.8 mm Hg for latanoprost. Netarsudil/latanoprost FDC met the criteria for superiority to each active component at all 9 time points (all P < .0001), lowering IOP by an additional 1.8-3.0 mm Hg vs netarsudil and an additional 1.3-2.5 mm Hg vs latanoprost. At month 3, the proportion of patients achieving mean diurnal IOP ≤15 mm Hg was 43.5% for netarsudil/latanoprost FDC, 22.7% for netarsudil, and 24.7% for latanoprost. No treatment-related serious adverse events were reported; treatment-related systemic adverse events were minimal. The most frequent ocular adverse event was conjunctival hyperemia (netarsudil/latanoprost FDC, 53.4%; netarsudil, 41.0%; latanoprost, 14.0%), which led to treatment discontinuation in 7.1% (netarsudil/latanoprost FDC), 4.9% (netarsudil), and 0% (latanoprost) of patients. CONCLUSIONS: Once-daily netarsudil/latanoprost FDC demonstrated IOP reductions that were statistically and clinically superior to netarsudil and latanoprost across all 9 time points through month 3, with acceptable ocular safety.


Assuntos
Benzoatos/uso terapêutico , Glaucoma de Ângulo Aberto/tratamento farmacológico , Pressão Intraocular/efeitos dos fármacos , Latanoprosta/uso terapêutico , beta-Alanina/análogos & derivados , Administração Oftálmica , Idoso , Anti-Hipertensivos/efeitos adversos , Anti-Hipertensivos/uso terapêutico , Benzoatos/efeitos adversos , Método Duplo-Cego , Combinação de Medicamentos , Feminino , Glaucoma de Ângulo Aberto/diagnóstico , Glaucoma de Ângulo Aberto/fisiopatologia , Humanos , Pressão Intraocular/fisiologia , Latanoprosta/efeitos adversos , Masculino , Pessoa de Meia-Idade , Hipertensão Ocular/diagnóstico , Hipertensão Ocular/tratamento farmacológico , Hipertensão Ocular/fisiopatologia , Soluções Oftálmicas , Tonometria Ocular , beta-Alanina/efeitos adversos , beta-Alanina/uso terapêutico , Quinases Associadas a rho/antagonistas & inibidores
17.
Am J Ophthalmol ; 208: 19-29, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31247169

RESUMO

PURPOSE: To test the hypothesis that baseline optical coherence tomography (OCT) measures predict visual field (VF) progression in a cohort of patients with suspected or established glaucoma and to compare their performance to semiquantitative optic disc measures. DESIGN: This was an observational cohort study. METHODS: The setting of this study was an academic institution. The study population included 171 eyes of 95 patients with good-quality baseline retinal nerve fiber layer (RNFL) and macular OCT images and disc photographs with >2 years of follow-up and ≥5 VFs. The observation procedures were baseline macular and RNFL OCT measures and cup-to-disc ratio and disc damage likelihood score. The main outcome measure was prediction of glaucomatous VF deterioration according to trend and event analyses. RESULTS: Median (interquartile range) baseline mean deviation and follow-up were -2.9 (-6.4 to -1.1) dB and 54 (44-65) months, respectively. Seventeen and 25 eyes progressed by final visit based on pointwise event analysis and trend analysis of visual field index (VFI), respectively. Thinner central corneal thickness (P = .005), female gender (P = .015), and thinner average peripapillary RNFL (P = .001) predicted VF progression on proportional hazard models. Thinner RNFL at baseline (P = .006) or thinner average ganglion cell-inner plexiform layer (P = .028) along with higher baseline VFI (P = .018 and .048, respectively) predicted VFI progression. Neither optic disc measures predicted VF progression in any of the explored models. CONCLUSIONS: Baseline structural OCT measures predicted subsequent VF progression in contrast to semi-quantitative optic disc measures. OCT-based structural measures should be included in prognostic models of glaucomatous VF deterioration.


Assuntos
Glaucoma de Ângulo Aberto/diagnóstico , Fibras Nervosas/patologia , Disco Óptico/patologia , Doenças do Nervo Óptico/diagnóstico , Células Ganglionares da Retina/patologia , Idoso , Paquimetria Corneana , Progressão da Doença , Feminino , Seguimentos , Humanos , Pressão Intraocular , Masculino , Pessoa de Meia-Idade , Hipertensão Ocular/diagnóstico , Disco Óptico/diagnóstico por imagem , Prognóstico , Estudos Retrospectivos , Microscopia com Lâmpada de Fenda , Tomografia de Coerência Óptica , Transtornos da Visão/diagnóstico , Transtornos da Visão/fisiopatologia , Acuidade Visual , Testes de Campo Visual , Campos Visuais/fisiologia
18.
Graefes Arch Clin Exp Ophthalmol ; 257(9): 2025-2032, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31222404

RESUMO

PURPOSE: To evaluate the correlation of the intraocular pressure measurements (IOP) with non-contact tonometer Corvis Scheimpflug technology (Corvis ST), Goldmann applanation tonometry (GAT), ocular response analyzer (ORA), and iCARE rebound tonometer in patients with thyroid-associated orbitopathy (TAO) and eye-healthy subjects (control group). METHODS: Twenty-nine consecutive patients with TAO (79% female) and 30 eye-healthy subjects (60% female) were included in this prospective, age- and sex-matched study. The IOP measurement with Corvis, ORA, GAT, iCARE, and central corneal thickness (CCT) with Corvis was obtained from all study participants. RESULTS: The mean age of the patients was 51 ± 10 years in patients with TAO and 56 ± 13 years in the control group. The mean IOP measurements with GAT, Corvis, ORA, and iCARE were 15.93 ± 4.42 mmHg, 18.10 ± 7.54 mmHg, 18.40 ± 7.93 mmHg, and 16.61 ± 7.96 mmHg in patients with TAO and 14.52 ± 3.02 mmHg, 14.48 ± 3.38 mmHg, 15.29 ± 4.64 mmHg, and 14.13 ± 3.85 mmHg in the control group (P = 0.157, P = 0.004, P = 0.017, and P = 0.176 respectively). The mean CCT was 547.5 ± 39.2 µm in patients with TAO and 560.8 ± 49.8 µm in the control group ( P= 0.261). CONCLUSIONS: The data collected shows an agreement between the iCARE and GAT IOP measurements in TAO patients and in eye-healthy patients. However, the mean value of IOP measurements with Corvis and ORA was significantly higher in patients with TAO in comparison with the control group (P = 0.044 and P = 0.029 respectively).


Assuntos
Oftalmopatia de Graves/fisiopatologia , Pressão Intraocular/fisiologia , Hipertensão Ocular/diagnóstico , Tonometria Ocular/instrumentação , Adulto , Idoso , Desenho de Equipamento , Feminino , Seguimentos , Oftalmopatia de Graves/complicações , Oftalmopatia de Graves/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Hipertensão Ocular/etiologia , Hipertensão Ocular/fisiopatologia , Estudos Prospectivos , Curva ROC , Reprodutibilidade dos Testes
19.
Surv Ophthalmol ; 64(6): 810-825, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31132392

RESUMO

Measuring intraocular pressure (IOP) is the cornerstone of a comprehensive glaucoma examination. In babies or small children, however, IOP measurements are problematic, cannot often be performed at the slit lamp, and sometimes require general anesthesia. Therefore, it is essential for an ophthalmologist who examines a pediatric patient to be aware of the different tonometers used in children, as well as the effects of central corneal thickness and anesthesia on IOP measurements. Goldmann applanation tonometry is the gold standard for IOP assessment. Most alternative tonometers tend to give higher IOP readings than the Goldmann applanation tonometer, and readings between different tonometers are often not interchangeable. Similar to Goldmann tonometry, many of these alternative tonometers are affected by central corneal thickness, with thicker corneas having artifactually high IOP readings and thinner corneas having artifactually lower IOP readings. Although various machines can be used to compensate for corneal factors (e.g., the dynamic contour tonometer and ocular response analyzer), it is important to be aware that certain ocular diseases can be associated with abnormal central corneal thickness values and that their IOP readings need to be interpreted accordingly. Because induction and anesthetics can affect IOP, office IOPs taken in awake patients are always the most accurate.


Assuntos
Glaucoma/diagnóstico , Pressão Intraocular/fisiologia , Hipertensão Ocular/diagnóstico , Tonometria Ocular/métodos , Anestésicos/farmacologia , Anestésicos/uso terapêutico , Criança , Humanos , Pressão Intraocular/efeitos dos fármacos , Hipertensão Ocular/fisiopatologia , Reprodutibilidade dos Testes , Tonometria Ocular/instrumentação
20.
Invest Ophthalmol Vis Sci ; 60(6): 2023-2033, 2019 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-31067322

RESUMO

Purpose: To investigate the posttreatment neuronal rescue effects of Lycium barbarum polysaccharides (LBP) in an acute ocular hypertensive (AOH) model. Methods: Intraocular pressure (IOP) was elevated manometrically to 80 mm Hg (AOH) or 15 mm Hg (sham) for 120 minutes in adult Sprague-Dawley rats. Five experimental groups were considered: Three AOH groups were pretreated with PBS (vehicle) (n = 9), LBP 1 mg/kg (n = 8), or 10 mg/kg (n = 13), and one AOH group was posttreated with LBP 10 mg/kg (n = 8), once daily. The sham cannulation group (n = 5) received no treatment. Pretreatments commenced 7 days before and posttreatment 6 hours after AOH, and continued up through postcannulation day 28. All the animals underwent optical coherence tomography and electroretinogram measurements at baseline and postcannulation days 10 and 28. The ganglion cell layer (GCL) densities were quantified at day 28. Results: Both inner retinal layer thickness (IRLT) and positive scotopic threshold response (pSTR) underwent significant reduction (≥50% of thickness and amplitude) in the vehicle group (P < 0.05). Pretreatment with LBP 1 and 10 mg/kg retained 77 ± 11% and 89 ± 8% of baseline IRLT, respectively, and preserved pSTR functions. The posttreatment group showed a significant reduction in IRLT (-35 ± 8%, P < 0.001) and pSTR (∼48% of baseline, P < 0.001) on day 10. By day 28, there was an improvement in functional pSTR (∼72% of baseline, P > 0.05) with no significant further thinning (-40 ± 8%, P = 0.15) relative to day 10. GCL density was reduced in vehicle control (P = 0.0001), but did not differ between sham and pre- and posttreated AOH groups. Conclusions: The rescue effect of LBP posttreatment was observed later, which arrested the secondary degeneration and improved the retinal function.


Assuntos
Medicamentos de Ervas Chinesas/farmacologia , Pressão Intraocular/fisiologia , Hipertensão Ocular/tratamento farmacológico , Células Ganglionares da Retina/patologia , Campos Visuais/fisiologia , Animais , Modelos Animais de Doenças , Eletrorretinografia , Feminino , Seguimentos , Pressão Intraocular/efeitos dos fármacos , Hipertensão Ocular/diagnóstico , Hipertensão Ocular/fisiopatologia , Ratos , Ratos Sprague-Dawley , Células Ganglionares da Retina/efeitos dos fármacos , Tomografia de Coerência Óptica , Resultado do Tratamento , Campos Visuais/efeitos dos fármacos
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