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1.
PLoS One ; 15(9): e0238395, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32966284

RESUMO

PURPOSE: The aim of the study was to investigate the effects of various anatomical structures on intraocular pressure (IOP) measurements obtained by the Corneal Visualization Scheimpflug Technology (Corvis ST), Goldmann applanation tonometer (GAT), and noncontact tonometer (NCT), as well as to assess the interchangeability among the four types of IOP measurement: IOP-GAT, IOP-NCT, IOP-Corvis, and biomechanically corrected IOP (bIOP-Corvis), with a particular focus on bIOP-Corvis. MATERIALS AND METHODS: We included 71 patients with primary open-angle glaucoma and assessed their IOP measurements obtained with the GAT, NCT, and Corvis ST using a repeated measures ANOVA, a paired t-test with Bonferroni correction, stepwise multiple regression analyses and Bland-Altman plots. RESULTS: IOP-GAT showed the highest values (13.5 ± 2.1 mmHg [mean ± standard deviation]), followed by IOP-NCT (13.2 ± 2.7 mmHg), IOP-Corvis (10.6 ± 2.8 mmHg), and bIOP-Corvis (10.0 ± 2.3 mmHg). With exceptions of bIOP-Corvis and IOP-GAT, all IOP variations were explained by regression coefficients involving the central corneal thickness. Bland-Altman plots showed a mean difference between IOP-GAT and the other IOP measurements (IOP-Corvis, bIOP-Corvis, and IOP-NCT), which were -2.90, -3.48, and -0.29 mmHg, respectively. The widths of the 95% limits of agreement between all pairs of IOP measurements were greater than 3 mmHg. CONCLUSION: IOP values obtained with the Corvis ST, NCT, and GAT were not interchangeable. The bIOP-Corvis measurement corrected for the ocular structure.


Assuntos
Glaucoma de Ângulo Aberto/fisiopatologia , Pressão Intraocular/fisiologia , Tonometria Ocular/métodos , Adulto , Idoso , Fenômenos Biomecânicos , Córnea/fisiologia , Córnea/fisiopatologia , Paquimetria Corneana , Feminino , Glaucoma de Ângulo Aberto/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Análise de Regressão , Tonometria Ocular/instrumentação , Tonometria Ocular/estatística & dados numéricos
2.
J Glaucoma ; 29(10): 999-1000, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32826763

RESUMO

Ophthalmological examination requires a strict contact between caregivers and patients. In the COVID-19 era, this may be a risk factor for virus spread, and the use of facial masks for all in-office ophthalmological procedures has been recommended. In this case-series, we report about some errors in intraocular pressure measurement, that may occur during the slit-lamp examination of patients wearing filtering facepiece masks and N95 respirators. This is mainly due to the greater dimensions of these masks in comparison with the surgical standard ones, and to the presence of a preshaped rigid nose area that may press against the Goldmann tonometer. Special care should be taken when measuring intraocular pressure in these cases.


Assuntos
Betacoronavirus , Infecções por Coronavirus/prevenção & controle , Glaucoma de Ângulo Aberto/fisiopatologia , Pressão Intraocular/fisiologia , Hipertensão Ocular/fisiopatologia , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Dispositivos de Proteção Respiratória , Tonometria Ocular , Adulto , Feminino , Humanos , Masculino , Máscaras , Pessoa de Meia-Idade , Microscopia com Lâmpada de Fenda
4.
PLoS One ; 15(8): e0238146, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32841295

RESUMO

We have previously developed a new theory for pressure dependent outflow from the human eye, and tested the model using experimental data at intraocular pressures above normal eye pressures. In this paper, we use our model to analyze a hypotensive pressure-time dataset obtained following application of a Honan balloon. Here we show that the hypotensive pressure-time data can be successfully analyzed using our proposed pressure dependent outflow model. When the most uncertain initial data point is removed from the dataset, then parameter estimates are close to our previous parameter estimates, but clearly parameter estimates are very sensitive to assumptions. We further show that (i) for a measured intraocular pressure-time curve, the estimated model parameter for whole eye surface hydraulic conductivity is primarily a function of the ocular rigidity, and (ii) the estimated model parameter that controls the rate of decrease of outflow with increasing pressure is primarily a function of the convexity of the monotonic pressure-time curve. Reducing parameter uncertainty could be accomplished using new technologies to obtain higher quality datasets, and by gathering additional data to better define model parameter ranges for the normal eye. With additional research, we expect the pressure dependent outflow analysis described herein may find applications in the differential diagnosis, prognosis and monitoring of the glaucomatous eye.


Assuntos
Pressão Intraocular/fisiologia , Modelos Biológicos , Fenômenos Fisiológicos Oculares , Bases de Dados Factuais , Olho/fisiopatologia , Glaucoma/diagnóstico , Glaucoma/fisiopatologia , Glaucoma/cirurgia , Humanos , Hidrodinâmica , Valores de Referência , Análise de Regressão , Fatores de Tempo , Tonometria Ocular
5.
PLoS One ; 15(7): e0235701, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32673335

RESUMO

OBJECTIVES: To investigate significant intraocular pressure (IOP) levels associated with the risk of open-angle glaucoma (OAG) in the treatment-naïve Korean population. METHODS: Participants ≥20 years of age in Korea National Health and Nutrition Examination Survey 2010-2011 were divided into two groups, those with higher and lower IOP values, compared with the reference IOP value. We compared the risk of OAG in each group using regression analyses. The IOP value that yielded the highest statistical significance was determined as an IOP significantly associated with the OAG risk. RESULTS: A total of 7,650 participants (7,292 control, 358 OAG) were included. The mean IOP was significantly higher in OAG group (14.4 ± 2.9 mmHg), compared to control group (13.9 ± 2.7 mmHg, P = 0.022). In association with an increased risk of OAG, the significant IOP value was 18 mmHg (Odds ratio [OR] = 1.79, 95% confidence interval [CI] 1.14-2.80, P = 0.011). Additionally, sex-difference was identified and they were 19 mmHg (OR = 2.79, 95% CI 1.27-6.16, P = 0.011) in men and 18 mmHg (OR = 2.65, 95% CI 1.32-5.33, P = 0.006) in women. The IOP values associated with significantly decreased risk of glaucoma were determined to be 14 mmHg in men (OR = 0.68, 95% CI 0.47-0.99, P = 0.042) and 16 mmHg in women (OR = 0.47, 95% CI 0.27-0.81, P = 0.007). CONCLUSIONS: In consideration of the risk to benefit ratio, the reference IOP level for screening or setting the target IOP for treatment could be considered different from traditional 21 mmHg in Korean population.


Assuntos
Glaucoma de Ângulo Aberto/diagnóstico , Pressão Intraocular/fisiologia , Inquéritos Nutricionais , Adulto , Estudos de Casos e Controles , Feminino , Glaucoma de Ângulo Aberto/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Razão de Chances , República da Coreia , Fatores de Risco
6.
Proc Natl Acad Sci U S A ; 117(31): 18810-18821, 2020 08 04.
Artigo em Inglês | MEDLINE | ID: mdl-32690710

RESUMO

In the central nervous system, glycogen-derived bioenergetic resources in astrocytes help promote tissue survival in response to focal neuronal stress. However, our understanding of the extent to which these resources are mobilized and utilized during neurodegeneration, especially in nearby regions that are not actively degenerating, remains incomplete. Here we modeled neurodegeneration in glaucoma, the world's leading cause of irreversible blindness, and measured how metabolites mobilize through astrocyte gap junctions composed of connexin 43 (Cx43). We elevated intraocular pressure in one eye and determined how astrocyte-derived metabolites in the contralateral optic projection responded. Remarkably, astrocyte networks expand and redistribute metabolites along distances even 10 mm in length, donating resources from the unstressed to the stressed projection in response to intraocular pressure elevation. While resource donation improves axon function and visual acuity in the directly stressed region, it renders the donating tissue susceptible to bioenergetic, structural, and physiological degradation. Intriguingly, when both projections are stressed in a WT animal, axon function and visual acuity equilibrate between the two projections even when each projection is stressed for a different length of time. This equilibration does not occur when Cx43 is not present. Thus, Cx43-mediated astrocyte metabolic networks serve as an endogenous mechanism used to mitigate bioenergetic stress and distribute the impact of neurodegenerative disease processes. Redistribution ultimately renders the donating optic nerve vulnerable to further metabolic stress, which could explain why local neurodegeneration does not remain confined, but eventually impacts healthy regions of the brain more broadly.


Assuntos
Astrócitos , Glaucoma/metabolismo , Doenças Neurodegenerativas/metabolismo , Animais , Astrócitos/metabolismo , Astrócitos/fisiologia , Conexina 43/genética , Conexina 43/metabolismo , Feminino , Junções Comunicantes/metabolismo , Pressão Intraocular/fisiologia , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Camundongos Transgênicos
7.
Middle East Afr J Ophthalmol ; 27(1): 40-46, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32549723

RESUMO

PURPOSE: The study aims to assess the efficacy and safety of Ahmed glaucoma valve implant in eyes with intractable glaucoma and to evaluate the risk factors for failure. METHODS: A retrospective evaluation of 83 patients (117 eyes) with intractable glaucoma who underwent silicone Ahmed glaucoma valve implant was done in a tertiary care center in Riyadh, Saudi Arabia, between January 2014 and December 2016. Complete success was defined as intraocular pressure (IOP) ≤21 mmHg without medication after a minimum follow-up of 6 months. RESULTS: Eighty-three patients (117 eyes) with intractable glaucoma were evaluated. After a mean follow-up duration of 20.8 ± 3.1 (12-24) months, the overall success rate was achieved in 104 eyes (88.9%). Thirty-six eyes (30.8%) had a complete success rate, whereas 68 eyes (58.1%) had a qualified success rate. Thirteen eyes (11.1%) failed to achieve controlled IOP. The postoperative probability to fail was found to be increasing with time from 0.9% (0.9) in the 1st month to 11.1% (9.9) after 1 year. Complications included a hypertensive phase in 25 eyes (21.4%), encapsulation in 10 eyes (8.5%), hyphema in 7 eyes (6%), hypotony in 2 eyes (1.7%), and blood clots in the implanted tube in 2 eyes (1.7%). The presence of hyphema, scleral patch, and coronary heart diseases was found to increase the risk of failure after Ahmed valve implantation (P = 0.006, 0.040, and 0.014, respectively). CONCLUSIONS: Ahmed glaucoma valve implant was safe and effective in treating cases of intractable glaucoma.


Assuntos
Implantes para Drenagem de Glaucoma , Glaucoma/cirurgia , Pressão Intraocular/fisiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Segurança de Equipamentos , Feminino , Seguimentos , Glaucoma/fisiopatologia , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Estudos Retrospectivos , Fatores de Risco , Arábia Saudita , Tonometria Ocular , Resultado do Tratamento , Acuidade Visual/fisiologia
8.
Middle East Afr J Ophthalmol ; 27(1): 53-55, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32549725

RESUMO

AIM: This study aimed to describe a novel approach to manage the challenges of phacoemulsification in vitrectomized eyes. METHODS: Intraoperative titrated intravitreal injection of balanced salt solution (BSS) through pars plana was done using a 30G needle hooked to a 1 cc syringe to build up the vitreous pressure. RESULTS: Five eyes of five patients who had previous vitrectomy were given intraoperative injection. This led to the prevention of lens-iris diaphragm retropulsion and routine completion of phacoemulsification. The preoperative visual acuity was < 6/60 in all patients. The postoperative visual acuity was 6/9 or better in all patients, except in one patient which was 6/60, which is explained by diabetic ischemic maculopathy. Neither injection-related intraoperative nor postoperative complications were noted. CONCLUSION: Challenges of phacoemulsification in vitrectomized eyes can be prevented by a simple titrated intraoperative injection of BSS intravitreally through pars plana.


Assuntos
Acetatos/administração & dosagem , Complicações Intraoperatórias/prevenção & controle , Minerais/administração & dosagem , Facoemulsificação/métodos , Cloreto de Sódio/administração & dosagem , Vitrectomia , Corpo Vítreo/cirurgia , Idoso , Combinação de Medicamentos , Feminino , Humanos , Pressão Intraocular/fisiologia , Injeções Intravítreas , Masculino , Pessoa de Meia-Idade , Acuidade Visual/fisiologia
9.
PLoS One ; 15(6): e0234042, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32492062

RESUMO

BACKGROUND: To elucidate the possible effect of various systemic factors on intraocular pressure (IOP) using a dataset from a health examination program database in Japan. METHODS: This cross-sectional study included 1569 subjects selected from the 2287 subjects who comprised the database. Various systemic parameters including age, sex, height, body weight, waist circumference, percent body fat, blood pressure (BP), pulse rate, body mass index, 28 blood examination values, intimal medial thicknesses of both carotid arteries, and intraocular pressure (IOP) values measured by non-contact tonometry in both eyes were collected. The possible correlation between the IOP and other parameters was assessed initially by univariate analyses followed by multivariate analyses. RESULTS: Stepwise multivariate analyses, which included all parameters extracted by the univariate analyses (p<0.1) and sex, identified the same six parameters as indicators of the IOP values for each right and left IOP model. Among the parameters, age (r = -0.05 and -0.04/year for right and left IOPs, respectively) was associated negatively and the percent body fat (r = 0.06 and 0.05/%), systolic BP (r = 0.02 and 0.03/mmHg), pulse rate (r = 0.03 and 0.03/counts/minutes), albumin (r = 1.12 and 1.00/g/dL), and hemoglobin A1c (r = 0.38 and 0.44/%) were associated positively with the IOP in each eye. CONCLUSIONS: Older age was associated with low IOP, while factors reflecting the metabolic syndrome were associated with high IOP in our study population.


Assuntos
Pressão Intraocular/fisiologia , Tecido Adiposo , Adulto , Idoso , Idoso de 80 Anos ou mais , Pressão Sanguínea , Índice de Massa Corporal , Estudos Transversais , Feminino , Hemoglobina A Glicada/análise , Frequência Cardíaca , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Albumina Sérica/análise
10.
PLoS One ; 15(5): e0233270, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32421695

RESUMO

PURPOSE: To investigate whether the position of the central vascular trunk, as a surrogate of lamina cribrosa (LC) shift, is associated with the initial hemisphere of visual field defect in myopic high-tension glaucoma (HTG) eyes. METHODS: The deviation of the central vascular trunk was measured from the center of the Bruch's membrane opening (BMO), which was delineated by OCT imaging. The angular deviation was measured with the horizontal nasal midline as 0° and the superior location as a positive value. The initial hemisphere developing visual field defect was defined as three connected abnormal points (having a P value with less than 0.5% probability of being normal) appearing in only one hemisphere in pattern deviation plots. If those points were observed in both hemispheres initially, the eye was classified as bi-hemispheric visual field defect. RESULTS: Initially, 36 eyes (44%) had superior visual field defects, 27 (33%) inferior visual field defects, and 18 (22%) bi-hemispheric visual field defects. After a mean follow-up of 5 years, the number of bi-hemispheric visual field defects had increased to 34 (42%). A logistic regression analysis revealed that inferior deviation of vascular trunk was the only factor associated with initial inferior visual field defect (P = 0.001), while initial bi-hemispheric visual field defects were associated with worse mean deviation at initial visits (P<0.001). A conditional inference tree analysis showed that both the angular deviation (P<0.001) and initial mean deviation (P = 0.025) determined the initial hemispheres developing visual field defect. CONCLUSIONS: Although both hemispheres were involved as glaucoma progression, the axons on the side counter to the vascular trunk deviation were damaged earlier in HTG. This finding implies the LC shift could add additional stress to axons exposed to high intraocular pressure.


Assuntos
Glaucoma/metabolismo , Glaucoma/patologia , Miopia/patologia , Adulto , Idoso , Axônios/fisiologia , Feminino , Humanos , Pressão Intraocular/fisiologia , Masculino , Pessoa de Meia-Idade , Miopia/metabolismo , Disco Óptico/metabolismo , Disco Óptico/patologia , Doenças do Nervo Óptico , Células Ganglionares da Retina/fisiologia , Vasos Retinianos/diagnóstico por imagem , Tomografia de Coerência Óptica/métodos , Tonometria Ocular/métodos , Acuidade Visual , Testes de Campo Visual/métodos , Campos Visuais/fisiologia
11.
PLoS One ; 15(5): e0232523, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32379837

RESUMO

Pulse wave attenuation characteristics reflect compliance and resistance properties of the vessel wall as well as initial pulse generation factors. Recently, it has become possible to measure and map the retinal vessel wall pulse wave amplitudes. Predictable pulse wave amplitude distribution may allow inferences to be made concerning vascular compliance and resistance. Twenty-eight eyes from sixteen subjects (8 male and 8 female) were examined using modified retinal photoplethysmography with simultaneous ophthalmodynamometry. This allowed the assessment of vessel wall pulsation amplitudes under a dynamic range of intraocular pressures. Pulse amplitudes were calculated using harmonic regression analysis. The pulse wave attenuation was measured under different ranges of ophthalmodynamometric force (ODF) as a function of distance along the vessel (VDist), which in turn was calculated in disc diameters (DD) from the center of the optic disc. A linear mixed-effects model with randomized slopes and intercepts was used to estimate the correlations between the logarithmically transformed harmonic regression wave amplitude (HRWa) and the Fourier trigonometric coefficients with the predictors (VDist and ODF). The retinal venous harmonic regression wave attenuation (coefficient value±standard error) -0.40±0.065/DD, (p-value < 0.00001, 95% confidence interval (CI) -0.53 to -0.27), which was approximately twice that of the arterial -0.17±0.048/DD, (p-value < 0.0004, 95% CI = -0.27 to -0.08). There was a positive correlation between attenuation of the harmonic regression wave and ophthalmodynamometric force in both vascular systems. The attenuation of all but the sine coefficient of the second Fourier harmonic (bn2) achieved statistical significance in the correlation with VDist. The cosine coefficient of the first Fourier harmonic an1 was the only coefficient to achieve statistical significance in the correlation with the predictors VDist and ODF in both vascular systems. The an1 coefficient value in the correlation with VDist was -3.79±0.78 and -1.269±0.37 (p < 0.0006), while this coefficient value in the correlation with ODF was 0.026±0.0099 and 0.009±0.04 (p < 0.01) in both the retinal veins and arteries respectively. The predictable attenuation characteristics in normal subjects suggest that this technique may allow the non-invasive quantification of retinal vascular compliance and other hemodynamic parameters.


Assuntos
Fotopletismografia , Fluxo Pulsátil/fisiologia , Vasos Retinianos/fisiologia , Adulto , Idoso , Feminino , Humanos , Pressão Intraocular/fisiologia , Masculino , Pessoa de Meia-Idade , Artéria Retiniana/fisiologia , Veia Retiniana/fisiologia , Resistência Vascular/fisiologia , Adulto Jovem
12.
Am J Ophthalmol ; 217: 287-296, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32387433

RESUMO

PURPOSE: To investigate the structural characteristics of the posterior sclera around the optic nerve head (ONH) in patients with normal-tension glaucoma (NTG) and myopia with central visual field (VF) defect. DESIGN: Cross-sectional study. METHODS: Ninety-seven eyes of 97 NTG patients with myopia were included in this study. Swedish interactive thresholding algorithm (SITA) 24-2 and 10-2 were both performed to compare the central VF with peripheral VF. Optic disc torsion, tilt, and peripapillary atrophy area were calculated in 2-dimensional disc photographs. The most posterior point-that is, the deepest point of the eye (DPE)-was identified in 3-dimensional en face optical coherence tomography results and related measurements were calculated using built-in software. RESULTS: Forty-two eyes had worse SITA 10-2 mean deviation (MD) than SITA 24-2 MD and they were assigned to the central dominant VF defect group. The central dominant VF defect group had larger disc torsion and ONH tilt angle and shallower disc-DPE depth than the peripheral dominant VF defect group. According to logistic regression analysis, large ONH tilt angle and shallow disc-DPE depth were significant factors associated with central visual function impairment. CONCLUSIONS: Subjects with worse central VF than peripheral showed greater peripapillary scleral deformation, such as in torsion and tilt. Their posterior scleral deformation appeared to be closer to the ONH. Scleral deformation around the ONH may be associated with papillomacular bundle and central VF defects.


Assuntos
Pressão Intraocular/fisiologia , Glaucoma de Baixa Tensão/fisiopatologia , Miopia/fisiopatologia , Disco Óptico/patologia , Esclera/patologia , Tomografia de Coerência Óptica/métodos , Campos Visuais/fisiologia , Estudos Transversais , Feminino , Seguimentos , Humanos , Glaucoma de Baixa Tensão/diagnóstico , Masculino , Pessoa de Meia-Idade , Miopia/diagnóstico , Estudos Retrospectivos
13.
Invest Ophthalmol Vis Sci ; 61(5): 33, 2020 05 11.
Artigo em Inglês | MEDLINE | ID: mdl-32428234

RESUMO

Purpose: This study aimed to investigate the role and pathophysiological mechanism of ATP binding cassette transporter A1 (ABCA1) in regulating the IOP and aqueous humor outflow. Methods: ABCA1 expression was measured in trabecular meshwork samples obtained from patients with POAG and human donor eyes by Western blot. To further evaluate the functional significance of ABCA1, porcine angular aqueous plexus (AAP) cells, which are equivalent to human Schlemm's canal endothelial cells, were either treated with ABCA1 agonist GW3965 or transduced with lentivirus expressing ABCA1-shRNA. Transendothelial electrical resistance, protein expression, and nitric oxide (NO) concentration were measured. GW3965 was administered by intracameral injection. IOP and aqueous humor outflow facility were also measured. Results: ABCA1 expression was significantly higher in the trabecular meshwork tissue of patients with POAG compared with controls. ABCA1 upregulation in angular aqueous plexus cells decreased the transendothelial electrical resistance in the angular aqueous plexus monolayers accompanied by a 0.56-fold decrease in caveolin-1 expression and a 2.85-fold and 1.17-fold increase in endothelial NO synthase expression and NO concentration, respectively (n = 3, P < 0.05). Conversely, ABCA1 downregulation increased transendothelial electrical resistance and caveolin-1 expression and decreased endothelial NO synthase expression and NO production (n = 3, P < 0.05). GW3965 decreased IOP and significantly increased conventional outflow facility (P < 0.05). Conclusions: Regulation of aqueous humor outflow via the caveolin-1/endothelial NO synthase/NO pathway is a newly defined function of ABCA1 that is different from its traditional role in mediating cholesterol efflux. ABCA1 is a compelling, novel therapeutic candidate for the treatment of glaucoma and ocular hypertension.


Assuntos
Transportador 1 de Cassete de Ligação de ATP/fisiologia , Caveolina 1/metabolismo , Glaucoma de Ângulo Aberto/metabolismo , Pressão Intraocular/fisiologia , Óxido Nítrico Sintase Tipo III/metabolismo , Óxido Nítrico/metabolismo , Transdução de Sinais/fisiologia , Animais , Humor Aquoso/fisiologia , Benzoatos/farmacologia , Benzilaminas/farmacologia , Western Blotting , Impedância Elétrica , Células Endoteliais/efeitos dos fármacos , Glaucoma de Ângulo Aberto/cirurgia , Humanos , Lentivirus/genética , RNA Interferente Pequeno/genética , Reação em Cadeia da Polimerase em Tempo Real , Suínos , Malha Trabecular/metabolismo , Trabeculectomia , Transfecção
14.
Invest Ophthalmol Vis Sci ; 61(5): 34, 2020 05 11.
Artigo em Inglês | MEDLINE | ID: mdl-32433759

RESUMO

Purpose: To examine the biomechanical effects-induced wave-front aberrations after conventional laser refractive surgery. Methods: A finite element model of the human eye was established to simulate conventional laser refractive surgery with corrected refraction from -1 to -15 diopters (D). The deformation of the anterior and posterior corneal surfaces was obtained under the intraocular pressure (IOP). Then, the surface displacement was converted to wave-front aberrations. Results: Following conventional refractive surgery, significant deformation of the anterior and posterior corneal surfaces occurred because of the corneal biomechanical effects, resulting in increased residual wave-front aberrations. Deformation of the anterior surface resulted in a hyperopic shift, which was significantly increased with the increasing refractive correction. The residual high-order aberrations consisted of spherical aberration, vertical coma, and y-trefoil. Spherical aberration was significantly positively correlated to enhanced refraction correction. The effect of posterior corneal surface on induced wave-front aberration was less than the anterior corneal surface. The IOP slightly affects the postoperative defocus, coma, and spherical aberration. When treatment decentration occurred during the procedure, the hyperopic shift decreased as the eccentricity increased. Treatment decentration had a significant impact on the spherical aberration and the coma. In addition, the ocular tissue elasticity played a key role in hyperopic shift, whereas it had little effect on the other aberrations. Conclusions: Among the many factors that affect high-order aberrations after conventional laser refractive surgery, the alterations in corneal morphology caused by biomechanical effects must be considered, as they can lead to an increase in postoperative residual wave-front aberrations.


Assuntos
Córnea/fisiopatologia , Cirurgia da Córnea a Laser/efeitos adversos , Aberrações de Frente de Onda da Córnea/etiologia , Análise de Elementos Finitos , Modelos Teóricos , Miopia/cirurgia , Fenômenos Biomecânicos , Aberrações de Frente de Onda da Córnea/fisiopatologia , Elasticidade/fisiologia , Humanos , Pressão Intraocular/fisiologia , Miopia/fisiopatologia , Refração Ocular/fisiologia , Acuidade Visual/fisiologia
15.
Invest Ophthalmol Vis Sci ; 61(5): 40, 2020 05 11.
Artigo em Inglês | MEDLINE | ID: mdl-32441758

RESUMO

Purpose: To investigate the morphologic features of crystalline lens in primary angle closure disease (PACD) by the swept-source anterior segment optical coherence tomography. Methods: This cross-sectional observational study included 125 consecutive eyes from 125 patients who underwent anterior segment optical coherence tomography (CASIA 2, Tomey, Nagoya, Japan) examination, including 38 eyes of normal controls, 57 eyes of PAC suspects (PACS), and 30 eyes with PAC or PAC glaucoma (PACG). Crystalline lens parameters were compared among the three groups. Spearman correlation analysis and multiple linear regression models were performed to evaluate the relationships between the lens parameters and related factors. Results: Significant differences were found for anterior chamber depth, axial length, iridotrabecular contact index, lens vault, lens thickness (all P < 0.001), the anterior radius curvature of lens (normal vs PACS vs PAC/PACG: 9.35 ± 1.29 mm vs 8.40 ± 0.62 mm vs 8.12 ± 0.54 mm; P < 0.001), lens decentration (normal vs PACS vs PAC/PACG: 0.14 ± 0.07 mm vs 0.19 ± 0.09 mm vs 0.22 ± 0.12 mm; P = 0.004), and tilt (normal vs PACS vs PAC/PACG: 4.9 ± 1.0° vs 5.3 ± 1.2° vs 5.8 ± 1.8°; P = 0.033) among the three groups. The multivariate regression analysis found that both iridotrabecular contact index and the stage of the PACD were negatively correlated with the anterior radius curvature of lens, positively correlated with lens thickness and decentration after adjustment for age, sex, and axial length (all P < 0.05). Conclusions: Steep anterior curvature and decentration of the crystalline lens may be another anatomic characteristic of eyes with PACD. These findings support that the crystalline lens morphologic features may have great contribution to the development of PACD.


Assuntos
Segmento Anterior do Olho/diagnóstico por imagem , Glaucoma de Ângulo Fechado/diagnóstico , Cristalino/patologia , Tomografia de Coerência Óptica , Idoso , Estudos Transversais , Feminino , Glaucoma de Ângulo Fechado/classificação , Gonioscopia , Humanos , Pressão Intraocular/fisiologia , Cristalino/diagnóstico por imagem , Masculino , Microscopia Acústica , Pessoa de Meia-Idade , Microscopia com Lâmpada de Fenda , Tonometria Ocular
16.
Am J Ophthalmol ; 217: 1-9, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32360859

RESUMO

PURPOSE: This report examines the relationship between glaucomatous macular damage and facial recognition. In addition, it assesses the role of contrast sensitivity (CS) as an intermediary step in the causal pathway between macular damage and impairment of facial recognition. DESIGN: Prospective cross-sectional study. METHODS: This study was conducted in a single tertiary care center. The study population included 144 eyes of 72 participants with a diagnosis of open angle glaucoma in one or both eyes and a visual acuity of 20/40 or better in each eye. The presence or absence of macular damage was determined by comparing corresponding regions of the retinal nerve fiber layer and the retinal ganglion cell layer with spectral-domain optical coherence tomography with the 10-2 visual field (VF). Better and worse eye was determined by 10-2 VF mean deviations (MDs). Interventions were 1) macular function as measured by 10-2 VF and 2) CS as measured by the Freiburg Visual Acuity and Contrast Test (FrACT). The primary outcome measure was the Cambridge Face Memory Test (CFMT) score. RESULTS: Regardless of eye, there was a significant correlation between facial recognition and 10-2 VF MD (P < .0001 better, worse eye). The 10-2 VF MD remained a significant predictor of facial recognition after adjusting for potential confounders including glaucoma severity, CS, age, and visual acuity (P = .004 better eye, P = .019 worse eye). CONCLUSIONS: Even with good central visual acuity, patients with glaucomatous macular damage exhibit diminished facial recognition, which is partly mediated through diminished CS.


Assuntos
Reconhecimento Facial/fisiologia , Glaucoma/fisiopatologia , Macula Lutea/patologia , Doenças Retinianas/diagnóstico , Acuidade Visual , Idoso , Estudos Transversais , Progressão da Doença , Feminino , Glaucoma/complicações , Glaucoma/diagnóstico , Humanos , Pressão Intraocular/fisiologia , Masculino , Fibras Nervosas/patologia , Disco Óptico/patologia , Estudos Prospectivos , Doenças Retinianas/etiologia , Doenças Retinianas/fisiopatologia , Células Ganglionares da Retina/patologia , Tomografia de Coerência Óptica/métodos , Campos Visuais
17.
Am J Ophthalmol ; 217: 55-67, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32360861

RESUMO

PURPOSE: To investigate an association between sex hormones and inflammatory cytokines, and to determine whether baseline 17-ß-estradiol (E2) and interleukin-8 (IL-8) are associated with visual field (VF) progression in postmenopausal women with primary angle closure glaucoma (PACG). DESIGN: A prospective cross-sectional and cohort study. PARTICIPANTS: The cross-sectional study enrolled 200 postmenopausal women with PACG and 151 healthy postmenopausal women as normal control subjects. A total of 105 postmenopausal women with PACG were included and followed up for ≥2 years in the cohort study. METHODS: All participants were evaluated for levels of baseline sex hormones (follicle-stimulating hormone, prolactin, progesterone, testosterone, luteinizing hormone, and E2) and inflammatory cytokines (IL-1, IL-2, IL-6, IL-8, IL-10, and C-reactive protein) and underwent VF examinations. The cross-sectional study was conducted to establish risk factors for postmenopausal women with PACG using logistic regression analysis. The cohort study was designed to identify factors that could be used to predict VF progression in postmenopausal women with PACG using multivariate Cox regression analyses. The main outcome measures included factors associated with VF progression over time. RESULTS: Decreased E2 (odds ratio 0.88 [95% confidence interval {CI} 0.78-0.99], P = .007) and increased IL-8 (odds ratio 1.12 [95% CI 1.01-1.23], P < .001) levels were risk factors in postmenopausal women with PACG. A significant negative correlation was observed between IL-8 levels and E2 (r = -0.21, P = .02). Multivariable regression analyses revealed a significant correlation between E2 levels and visual field mean deviation (MD) (B = -0.16, P = .04 [95% CI -.09 to -.003) and between IL-8 levels and MD (B = 0.36, P < .001 [95% CI 0.01-0.02]). During follow-up, 48 (45.71%) patients showed VF progression. Lower baseline E2 (hazard ratio 0.85 [95% CI 0.82-0.88], P = .04) and higher baseline IL-8 levels (hazard ratio 1.01 [95% CI 1.00-1.02], P = .004) were associated with progression of glaucoma. Patients with lower E2 levels had a significantly higher rate of PACG progression (log-rank test P < .001), similar to those with higher IL-8 levels (log-rank test P = .04). CONCLUSIONS: Decreased E2 and increased IL-8 levels at baseline are significant predictors of VF progression in postmenopausal women with PACG.


Assuntos
Estradiol/sangue , Glaucoma de Ângulo Fechado/sangue , Interleucina-8/sangue , Pressão Intraocular/fisiologia , Pós-Menopausa/sangue , Escotoma/etiologia , Campos Visuais/fisiologia , Biomarcadores/sangue , Estudos Transversais , Progressão da Doença , Feminino , Seguimentos , Glaucoma de Ângulo Fechado/complicações , Glaucoma de Ângulo Fechado/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos , Escotoma/sangue , Escotoma/fisiopatologia , Fatores de Tempo
18.
Invest Ophthalmol Vis Sci ; 61(5): 6, 2020 05 11.
Artigo em Inglês | MEDLINE | ID: mdl-32392314

RESUMO

Purpose: To study the time-dependent effects of reduced cerebrospinal fluid pressure (CSFP) on axonal transport in the rat optic nerve. Methods: Seventy-two adult Sprague Dawley rats were used for this study. Fluoro-Gold was injected into the superior colliculi to study axonal transport. CSFP was reduced to 1.5 to 2.9 mm Hg by continuous aspiration of cerebrospinal fluid. In the sham control group (n = 18), a trocar was implanted in the cisterna magna, but cerebrospinal fluid was not released. CSFP and intraocular pressure (IOP) were continually monitored. CSFP was reduced for 1 hour (low-CSFP-1h study group; n = 18), 3 hours (low-CSFP-3h study group; n = 18), or 6 hours (low-CSFP-6h study group; n = 18) before the animals were euthanized. Confocal microscopy was used to compare axonal transport in different quadrants of the retina between control and low-CSFP eyes. Results: Changes in axonal transport were observed only after 3 hours of CSFP reduction and not in the low-CSFP-1h study group. These changes occurred in a time-dependent manner, with 6 hours of CSFP reduction producing the longest lasting and most severe reduction in fluorescence. Conclusions: The time-dependent changes observed in axonal transport in the optic nerve provide further evidence regarding the pathogenesis of axonal damage caused by reduced CSFP.


Assuntos
Transporte Axonal/fisiologia , Pressão do Líquido Cefalorraquidiano/fisiologia , Pressão Intraocular/fisiologia , Nervo Óptico/metabolismo , Animais , Microscopia Confocal , Modelos Animais , Nervo Óptico/citologia , Ratos Sprague-Dawley , Células Ganglionares da Retina/patologia , Fatores de Tempo
19.
Invest Ophthalmol Vis Sci ; 61(5): 16, 2020 05 11.
Artigo em Inglês | MEDLINE | ID: mdl-32407519

RESUMO

Purpose: Glaucoma is the second leading cause of blindness worldwide. Recent work suggests that estrogen and the timing of menopause play a role in modulating the risk of developing glaucoma. Menopause is known to cause modest changes in intraocular pressure; yet, whether this change is mediated through the outflow pathway remains unknown. Menopause also affects tissue biomechanical properties throughout the body; however, the impact of menopause on ocular biomechanical properties is not well characterized. Methods: Here, we simultaneously assessed the impact of menopause on aqueous outflow facility and ocular compliance, as a measure of corneoscleral shell biomechanics. We used young (3-4 months old) and middle-aged (9-10 months old) Brown Norway rats. Menopause was induced by ovariectomy (OVX), and control animals underwent sham surgery, resulting in the following groups: young sham (n = 5), young OVX (n = 6), middle-aged sham (n = 5), and middle-aged OVX (n = 5). Eight weeks postoperatively, we measured outflow facility and ocular compliance. Results: Menopause resulted in a 34% decrease in outflow facility and a 19% increase in ocular compliance (P = 0.011) in OVX animals compared with sham controls (P = 0.019). Conclusions: These observations reveal that menopause affects several key physiological factors known to be associated with glaucoma, suggesting that menopause may contribute to an increased risk of glaucoma in women.


Assuntos
Envelhecimento/fisiologia , Humor Aquoso/metabolismo , Pressão Intraocular/fisiologia , Menopausa/fisiologia , Animais , Feminino , Modelos Animais , Modelos Estatísticos , Perfusão , Ratos
20.
Proc Natl Acad Sci U S A ; 117(23): 12856-12867, 2020 06 09.
Artigo em Inglês | MEDLINE | ID: mdl-32439707

RESUMO

The conventional outflow pathway is a complex tissue responsible for maintaining intraocular pressure (IOP) homeostasis. The coordinated effort of multiple cells with differing responsibilities ensures healthy outflow function and IOP maintenance. Dysfunction of one or more resident cell types results in ocular hypertension and risk for glaucoma, a leading cause of blindness. In this study, single-cell RNA sequencing was performed to generate a comprehensive cell atlas of human conventional outflow tissues. We obtained expression profiles of 17,757 genes from 8,758 cells from eight eyes of human donors representing the outflow cell transcriptome. Upon clustering analysis, 12 distinct cell types were identified, and region-specific expression of candidate genes was mapped in human tissues. Significantly, we identified two distinct expression patterns (myofibroblast- and fibroblast-like) from cells located in the trabecular meshwork (TM), the primary structural component of the conventional outflow pathway. We also located Schwann cell and macrophage signatures in the TM. The second primary component structure, Schlemm's canal, displayed a unique combination of lymphatic/blood vascular gene expression. Other expression clusters corresponded to cells from neighboring tissues, predominantly in the ciliary muscle/scleral spur, which together correspond to the uveoscleral outflow pathway. Importantly, the utility of our atlas was demonstrated by mapping glaucoma-relevant genes to outflow cell clusters. Our study provides a comprehensive molecular and cellular classification of conventional and unconventional outflow pathway structures responsible for IOP homeostasis.


Assuntos
Humor Aquoso/metabolismo , Glaucoma/patologia , Pressão Intraocular/fisiologia , Miofibroblastos/metabolismo , Malha Trabecular/metabolismo , Glaucoma/genética , Humanos , Macrófagos/metabolismo , RNA-Seq , Células de Schwann/metabolismo , Análise de Célula Única , Malha Trabecular/citologia
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