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1.
Medicine (Baltimore) ; 98(43): e17598, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31651867

RESUMO

Emerging evidences had reported the positive relationship between obesity and intraocular pressure (IOP). The aim of the present study was to investigate the association between hepatic steatosis and IOP in an adult Taiwanese population.Seven thousand seven hundred twelve males and 6325 females who received a health examination at the Tri-Service General Hospital during the period from 2010 to 2016 were included in this study.IOP was measured by noncontact tonometry. Hepatic steatosis was diagnosed by abdominal ultrasound examination. Multivariate regression analyses were used to assess the associations among various anthropometric parameters and IOP.After adjusting for pertinent covariables, hepatic steatosis had a closer association with increased IOP than percentage body fat, body mass index, or waist circumference (ß = 0.017, 95% confidence interval [CI] = 0.006, 0.028). This relationship remained significant among males in the study population (ß = 0.015, 95% CI = 0.001, 0.029). Furthermore, hepatic steatosis was significantly correlated with increased risk of high IOP (odd ratios = 1.235, 95% CI = 1.041-1.465).Our study highlights that hepatic steatosis is a better index for assessing the relationship with increased IOP than other anthropometric parameters. Underlying pathophysiological mechanisms regulating the association between hepatic steatosis and increasing IOP and even the risk of glaucoma should be examined in further studies.


Assuntos
Índice de Massa Corporal , Fígado Gorduroso/fisiopatologia , Pressão Intraocular/fisiologia , Circunferência da Cintura/fisiologia , Adulto , Antropometria , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Taiwan/epidemiologia , Tonometria Ocular
2.
Medicine (Baltimore) ; 98(42): e17654, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31626152

RESUMO

BACKGROUND: The aim of this meta-analysis is to compare the efficacy and safety of combined phacoemulsification (Phaco) with goniosynechialysis (GSL) to either Phaco or to Phaco combined with trabeculectomy or trabeculectomy alone in patients with angle closure glaucoma (ACG). METHODS: Five main electronic databases were searched for the eligible studies. Intraocular pressure (IOP) decrease was set as the primary outcome, while anti-glaucomatous medication decrease, changes of anterior chamber depth (ACD), range of peripheral anterior synechia (PAS), and complication occurrence were the secondary outcomes. Standard mean difference (SMD) and relative risk (RR) were the size effects for continuous and binomial data, respectively. Either fixed-effects model or random-effects model was chosen to pool the data based on the heterogeneities. RESULTS: A total of 7 eligible studies were included. The combined data showed the IOP decreased more significantly after Phaco-GSL than that after Phaco alone (SMD = -0.42,95%CI: -0.70 - 0.14, I = 17.6%, Z = 2.90, P = .004). However, there were no distinct differences regarding medication decrease (SMD =  -0.25,95%CI: -0.70 - 0.21, I = 0%, Z = 1.06, P = 0.29), ACD, the range of PAS and complication occurrence rate when compared Phaco-GSL to Phaco. Moreover, Phaco-GSL was comparable to Phaco-trabeculectomy/trabeculectomy in decreasing IOP (SMD =  -0.08, 95%CI = -0.32 - 0.15, I = 0%, Z = 0.70, P = .49). CONCLUSIONS: Phaco-GSL might be an optimal procedure to treat ACG with concomitant cataract due to its bleb-less nature, and its capacity for lowering IOP seems superior to Phaco alone and comparable to Phaco-trabeculectomy/trabeculectomy.


Assuntos
Catarata/complicações , Corpo Ciliar/cirurgia , Glaucoma de Ângulo Fechado/cirurgia , Pressão Intraocular/fisiologia , Facoemulsificação/métodos , Glaucoma de Ângulo Fechado/complicações , Glaucoma de Ângulo Fechado/fisiopatologia , Humanos , Trabeculectomia/métodos , Acuidade Visual
3.
Adv Clin Exp Med ; 28(10): 1367-1375, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31518493

RESUMO

BACKGROUND: Glaucoma, a degenerative and progressive disease, leads to structural and functional changes in the optic nerve head and retinal ganglion cells (RGCs), while the vasculature of the iris stays intact. OBJECTIVES: The aim of this study was to determine whether the coherence level associated with pupil geometry and peripheral arterial pulsation can be the basis for differentiating glaucoma and glaucoma-suspected patients from a control group. MATERIAL AND METHODS: This is an investigator-initiated, single-center prospective cohort study. Patients with diagnosed glaucoma (glaucoma group - GG) or glaucoma suspects (glaucoma suspects group - GSG), as well as healthy participants (control group - CG), were prospectively enrolled in the study. Glaucoma-diagnosed patients and glaucoma suspects who converted to glaucoma within 5 years were included. All patients underwent a full ophthalmological examination that included measurements of the thicknesses of the retinal nerve fiber layer (RNFL) and the ganglion cell complex (GCC) along with other parameters. A custom-made pupilometer was synchronized with a pulsometer to simultaneously record an image of the pupil and the peripheral arterial pulsation signal. All readings were processed with a script developed by the researchers. The main indicator of an increased influence of the vascular structures of the iris on pupil geometry in the patients and CG were the coherence levels (levC) between parameters describing the pupillary shape and peripheral arterial pulsation. RESULTS: Differences in the median value of the levCpS, levCpε and levCpθ parameters between the GG and GSG compared to the CG were found (p < 0.001). During the follow-up period, a larger decrease was observed in RNFL thickness and GCC thickness in the GSG than in the GG (p < 0.05). Strong correlations were found between levCpS and RNFL and GCC loss among the GSG group (p < 0.001), while in the GG this parameter correlated with RNFL and GCC thickness (p < 0.001). CONCLUSIONS: This is the first attempt to relate changes in the neuronal signaling pathways in glaucoma to the vascular-dependent changes of pupil geometry. The findings presented herein suggest that this approach can be used to determine which glaucoma suspects have autonomic system impairment in the eye, increasing their probability of glaucoma conversion.


Assuntos
Glaucoma de Ângulo Aberto/fisiopatologia , Glaucoma/diagnóstico , Fibras Nervosas/patologia , Células Ganglionares da Retina/patologia , Tomografia de Coerência Óptica/métodos , Estudos de Casos e Controles , Glaucoma de Ângulo Aberto/diagnóstico , Homeostase , Humanos , Pressão Intraocular/fisiologia , Estudos Prospectivos , Pupila
4.
Middle East Afr J Ophthalmol ; 26(2): 60-64, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31543661

RESUMO

PURPOSE: The purpose of the study is to evaluate the changes in contrast sensitivity (CS) after using the four different types of antiglaucoma eye drops in patients with primary open-angle glaucoma (POAG) by OPTEC-functional vision analyzer (FVA). METHODS: In this prospective study, eighty patients (80 eyes) with POAG were randomly divided into four groups. The groups were randomly received timolol maleate 0.5%, travoprost 0.004%, dorzolamide 2%, and brimonidine tartrate 0.2%. The medications were used in the eye that was randomly selected. The CS was assessed before and 15 min after the intervention by the FVA. The paired t-test was used to compare the difference between before and after the intervention. P < 0.05 was considered statistically significant. RESULTS: Fifteen minutes after the instillation of timolol maleate (Group A), the CS in three out of twenty patients at the spatial frequencies of 1.5, and 3 cycles per degree (cpd) was significantly decreased (P = 0.015). However, using travoprost (Group B) and dorzolamide (Group C), the CS in one out of twenty patients at low spatial frequencies (1.5 and 3 cpd) was decreased in the two groups, which was not statistically significant for these medications (P > 0.05). In Group D, after applying brimonidine tartrate, the CS in two out of twenty patients at the spatial frequency of 18 cpd was significantly decreased (P = 0.042). CONCLUSION: Our study showed that CS values at low and high spatial frequencies after applying timolol and brimonidine eye drops are temporarily reduced in patients with POAG.


Assuntos
Anti-Hipertensivos/uso terapêutico , Sensibilidades de Contraste/fisiologia , Glaucoma de Ângulo Aberto/tratamento farmacológico , Glaucoma de Ângulo Aberto/fisiopatologia , Testes Visuais/instrumentação , Adulto , Tartarato de Brimonidina/uso terapêutico , Feminino , Humanos , Pressão Intraocular/fisiologia , Masculino , Pessoa de Meia-Idade , Soluções Oftálmicas , Estudos Prospectivos , Sulfonamidas/uso terapêutico , Tiofenos/uso terapêutico , Timolol/uso terapêutico , Travoprost/uso terapêutico , Testes de Campo Visual , Campos Visuais/fisiologia
5.
Expert Opin Ther Pat ; 29(10): 829-839, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31510806

RESUMO

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


Assuntos
Biomarcadores/metabolismo , Glaucoma/diagnóstico , Biologia Molecular/métodos , Animais , Progressão da Doença , Diagnóstico Precoce , Glaucoma/fisiopatologia , Humanos , Pressão Intraocular/fisiologia , Patentes como Assunto , Testes de Campo Visual
6.
Asia Pac J Ophthalmol (Phila) ; 8(4): 308-313, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31369406

RESUMO

PURPOSE: The aim of the current study was to compare visco-trabeculotomy (VT) with standard trabeculectomy with mitomycin C (Trab-MMC) in the treatment of quiescent neovascular glaucoma (NVG). METHODS: The study was conducted on 51 eyes of 51 patients presenting with NVG and treated at an Ophthalmic Center in Egypt between March 2014 and April 2017. All study eyes were subjected to a standard protocol of intravitreal injection of ranibizumab followed by panretinal photocoagulation. Eyes were then randomized to either VT or Trab-MMC. Study eyes were followed up for at least 18 months. Success was defined as an intraocular pressure of ≤21 mm Hg and without vision-threatening complications. Complications were noted. RESULTS: The mean ±â€ŠSD (range, median) age of the study patients was 54.1 ±â€Š6.4 (40-67, 54.5) and 52.4 ±â€Š8.8 (38-66, 53) years in the VT (26 eyes) and Trab-MMC (25 eyes) groups, respectively (P = 0.45). The mean ±â€ŠSD (range, median) intraocular pressure (IOP) of the study eyes was 45.19 ±â€Š2.97 (39-52, 45.5) and 45.64 ±â€Š3.56 (3-53, 45) mm Hg on maximal medical therapy in the VT and Trab-MMC groups, respectively (P = 0.61). At 18 months' follow-up, the mean ±â€ŠSD (range, median) IOP of the study eyes was 18.19 ±â€Š2.0 (16-23, 17) and 19.92 ±â€Š2.6 (18-26, 19) mm Hg in the VT and Trab-MMC groups, respectively (P = 0.004). There was no difference in postoperative antiglaucoma medication between the 2 groups (P = 0.62). Complications included hyphema and Descemet split in the VT group and an IOP spike in the Trab-MMC group. Success rates were 84.6% and 80% in the VT and Trab-MMC groups, respectively (P = 0.726). CONCLUSIONS: Both VT and Trab-MMC groups are effective in reducing the IOP in cases of NVG after control of neovascularization with anti-vascular endothelial growth factor and pan retinal photocoagulation.


Assuntos
Glaucoma Neovascular/terapia , Pressão Intraocular/fisiologia , Fotocoagulação/métodos , Ranibizumab/administração & dosagem , Trabeculectomia/métodos , Acuidade Visual , Adulto , Idoso , Inibidores da Angiogênese/administração & dosagem , Feminino , Seguimentos , Glaucoma Neovascular/fisiopatologia , Humanos , Injeções Intravítreas , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Fator A de Crescimento do Endotélio Vascular/antagonistas & inibidores
7.
BMC Ophthalmol ; 19(1): 172, 2019 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-31391006

RESUMO

BACKGROUND: To evaluate corneal biomechanical properties by the Ocular Response Analyzer (ORA) in non keratoconic patients underwent penetrating keratoplasty (PK). METHODS: Corneal hysteresis (CH), corneal resistance factor (CRF), Goldmann- correlated intraocular pressure (IOPg), cornea-compensated IOP (IOPcc) using the ORA, and central graft thickness (CGT) were measured in 30 eyes at least two years after penetrating keratoplasty for non keratoconic indications. IOP using the Goldmann applanation tonometer (GAT) was also obtained after compensation for graft thickness and astigmatism. RESULTS: The mean age of patients was 33.1 ± 10.13 years; indications for PK were herpetic corneal scar (53.3%), corneal stromal dystrophy (23.3%), traumatic corneal opacity (10%), chemical corneal opacity (6.7%), and Fuchs endothelial dystrophy (6.7%). Mean CH and CRF were 8.52 ± 1.81 mmHg, and 8.56 ± 1.59 mmHg, respectively. Mean CGT was 532.43 ± 30 µm. Mean IOP GAT, IOPg, and IOPcc were 11.88 ± 3.66, 14.64 ± 4.08, and 17.27 ± 4.60 mmHg, respectively (P < 0.001). No significant association was found between CGT and IOP readings obtained using either the ORA or GAT. There were significant negative association between CH with both IOP GAT and IOPcc, while CRF had significant positive association with IOPg. CONCLUSION: After penetrating keratoplasty for non keratoconic patients, graft biomechanics does not return to average values even 2 years after the operation; moreover, intraocular pressure measurement with ORA gives higher values than thickness compensated GAT.


Assuntos
Córnea/fisiopatologia , Opacidade da Córnea/cirurgia , Distrofia Endotelial de Fuchs/cirurgia , Pressão Intraocular/fisiologia , Ceratoplastia Penetrante/métodos , Adulto , Idoso , Córnea/cirurgia , Opacidade da Córnea/fisiopatologia , Estudos Transversais , Elasticidade , Feminino , Seguimentos , Distrofia Endotelial de Fuchs/fisiopatologia , Humanos , Ceratocone , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Tempo , Tonometria Ocular/métodos , Acuidade Visual , Adulto Jovem
8.
BMC Ophthalmol ; 19(1): 175, 2019 Aug 08.
Artigo em Inglês | MEDLINE | ID: mdl-31395046

RESUMO

BACKGROUND: To assess the relationship between different indications for trans pars plana vitrectomies (PPV's) and the intraocular pressure (IOP), and the effect of multiple PPV's on the IOP. We also examined whether there were differences in the number of IOP-lowering medications or surgeries before and after PPV. METHODS: A retrospective study including all patients that underwent at least one PPV in the period from 2001 till 2014 at our clinic. Medical records of all patients were reviewed and clinically relevant data were entered in a database. Generalized estimating equations models for repeated measurements were used to examine the effect of the number of PPV's on the IOP and on the risk of undergoing glaucoma surgery, for each of the indications for PPV. RESULTS: Of 1072 PPV's 447 eyes fulfilled the inclusion criteria. The IOP increased with 3.0 mmHg after a PPV with indication retinal detachment (p < 0.001), but remained stable after PPV for epiretinal membrane (p = 0.555), macular hole (p = 0.695), and vitreous hemorrhage (p = 0.787). At the end of the follow-up period the number of IOP-lowering medications was significantly higher compared to baseline, except in the macular hole group (p = 0.103). Also, the number of eyes that underwent glaucoma surgery was significantly higher compared to the fellow (not-operated) eyes (p < 0.001). There was a significant association between the number of PPV's and the final IOP for the indication retinal detachment (p = 0.009), and between the number of PPV's and glaucoma surgery (odds ratio [95% confidence interval]: 2.60 [1.62-4.15]). CONCLUSIONS: The IOP rises significantly after PPV with indication retinal detachment. This association was not found for other indications for PPV. Also, the risk of IOP-lowering surgeries was higher after PPV, but not different between the PPV indications. The IOP should be monitored carefully after PPV, since there may be a higher risk of secondary glaucoma.


Assuntos
Previsões , Pressão Intraocular/fisiologia , Complicações Pós-Operatórias/epidemiologia , Doenças Retinianas/cirurgia , Vitrectomia/métodos , Idoso , Feminino , Seguimentos , Humanos , Masculino , Países Baixos/epidemiologia , Reoperação/tendências , Doenças Retinianas/fisiopatologia , Estudos Retrospectivos , Fatores de Risco , Tonometria Ocular , Acuidade Visual
9.
BMC Ophthalmol ; 19(1): 166, 2019 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-31366381

RESUMO

BACKGROUND: The cost of managing a chronic disease like glaucoma is quite large. A convenient and economical monitoring tool like self-reported measures of Quality of Life (QoL) could have the potential to significantly reduce the health economic burden of this disease. However, evidence about whether QoL can effectively reflect both subjective and objective clinical outcomes of visual functions in glaucoma patients is lacking. In this paper, we examined the relationships between both subjective and objective visual functions and QoL in glaucoma patients. METHODS: This cross-sectional study enrolled 107 patients with a broad range of glaucomatous visual function loss. Subjective visual function loss was assessed using tests of visual acuity (VA), contrast sensitivity (CS) and visual field (VF). Evaluation of objective visual function was performed using pattern visual evoked potentials (PVEP). National Eye Institute Visual Function Questionnaire 25 (NEI VFQ-25) and Glaucoma Quality of Life-15 (GQL-15) were used to measure QoL. Uni- and multivariable linear regression analyses were performed to investigate the associations between all the clinical variables with Rasch-calibrated QoL scores. RESULTS: Univariate analysis revealed that worse Rasch-calibrated NEI VFQ and GQL scores were associated with poorer VA and CS in both the better eye (BE) and the worse eye (WE), and with worse VF mean deviation, VF pattern standard deviation and PVEP latency and amplitude in 15 min check size in the WE (P < 0.05). Multivariable linear regression analysis revealed that, after adjusting for age, gender, duration of glaucoma, glaucoma severity and glaucoma type, Rasch-calibrated NEI VFQ-25 person measure scores were significantly associated with PVEP latency in 15 min check size [ß = - 0.347, 95% CI: (- 0.618, - 0.118), P = 0.001] in the WE; Rasch-calibrated GQL-15 person measure scores were significantly associated with PVEP amplitude in 15 min check size [ß = - 0.338, 95% CI: (- 0.588, - 0.108), P < 0.001] in the WE. CONCLUSIONS: Self-reported measures of QoL could be supplemental tools for assessing both subjective and objective visual functions in glaucoma patients.


Assuntos
Sensibilidades de Contraste/fisiologia , Potenciais Evocados Visuais/fisiologia , Glaucoma/fisiopatologia , Pressão Intraocular/fisiologia , Qualidade de Vida , Acuidade Visual , Campos Visuais/fisiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , China/epidemiologia , Estudos Transversais , Feminino , Glaucoma/epidemiologia , Glaucoma/psicologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Inquéritos e Questionários
10.
BMC Ophthalmol ; 19(1): 170, 2019 Aug 05.
Artigo em Inglês | MEDLINE | ID: mdl-31382918

RESUMO

BACKGROUND: To assess bioactive transforming growth factor-ß2 (TGFß2) and secreted frizzled-related protein-1 (SFRP1) levels in aqueous humor (AH) of different types of glaucoma. METHODS: AH samples were obtained immediately before ophthalmic surgery with a 27-gauge needle attached to a microsyringe from 126 eyes (105 patients) divided into five groups: cataract (control), primary open-angle glaucoma (POAG), chronic angle-closure glaucoma (CACG), primary angle-closure suspects (PACS), and acute angle-closure glaucoma (AACG). Bioactive TGFß2 and SFRP1 levels were assayed by ELISA. RESULTS: The concentration of TGFß2 in AH of POAG patients, but not CACG, PACS, or AACG patients, was significantly higher than control eyes. However, within the AACG group, although the TGFß2 levels in AH did not differ significantly from the control level when all AACG patients were grouped together, there were differences when the AACG patients were divided into high and normal intraocular pressure (IOP); TGFß2 of AACG patients with high IOP (> 21 mmHg) was significantly higher than those with normal IOP. AH levels of SFRP1 were not significantly different among the groups. However, a statistical significant, negative correlation between SFRP1 and IOP existed in the POAG group. POAG patients with high IOP had lower levels of SFRP1 than those with normal IOP. In contrast, a significant, positive correlation between SFRP1 level and IOP was detected in the AACG group. AACG patients with high IOP had a higher level of SFRP1 than those with normal IOP. Concentrations of TGFß2 and SFRP1 did not correlate significantly with each other, or with age. CONCLUSIONS: These results indicate that AH levels of TGFß2 and SFRP1 showed different profiles in different types of glaucomas.


Assuntos
Humor Aquoso/metabolismo , Glaucoma de Ângulo Fechado/metabolismo , Glaucoma de Ângulo Aberto/metabolismo , Pressão Intraocular/fisiologia , Proteínas/metabolismo , Fator de Crescimento Transformador beta2/metabolismo , Idoso , Biomarcadores/metabolismo , Ensaio de Imunoadsorção Enzimática , Feminino , Glaucoma de Ângulo Fechado/fisiopatologia , Glaucoma de Ângulo Aberto/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade
11.
BMC Ophthalmol ; 19(1): 192, 2019 Aug 22.
Artigo em Inglês | MEDLINE | ID: mdl-31438884

RESUMO

BACKGROUND: A patient's perception of how their glaucoma is managed will influence both adherence to their medication and outcome measures such as quality of life. METHODS: Prospective consecutive study using a Glaucoma Patient-reported Outcome and Experience Measure (POEM) modified for an Australian ophthalmic private clinical practice setting. The Australian Glaucoma POEM consists of eight items related to the patient's understanding of the diagnosis and management, acceptability of the treatment, whether they feel their glaucoma is getting worse, interfering with their daily life and concerns regarding loss of vision as well as addressing whether they feel safe under the care of their glaucoma team and how well their care is organised. RESULTS: Two hundred and two patients (M:F 91:111) participated in the study. Mean ± standard deviation for subject age was 69 ± 13 years. Patient's overall perception of their treatment and outcome was favourable. Younger patients felt their glaucoma interfered more with their daily lives and were more worried about losing vision from glaucoma. The greater the number of medications in use, the more they felt their glaucoma was getting worse and that glaucoma interfered with their daily lives. With all other variables accounted for by the multivariate linear model, female patients more strongly agreed that they understood their glaucoma diagnosis and glaucoma management. The patients with a severe visual defect in their worse eye, reported a greater perceived understanding of their glaucoma diagnosis and management and that they felt that glaucoma had a greater interference on their daily life. They were also more concerned about losing vision from glaucoma than their fellow glaucoma patients with less severe or no visual field deficit in the worse eye. CONCLUSIONS: The modified POEM demonstrates potential to capture the concerns of a practice's glaucoma cohort with a view to enhancing the quality of glaucoma care delivered.


Assuntos
Glaucoma/terapia , Pressão Intraocular/fisiologia , Medidas de Resultados Relatados pelo Paciente , Qualidade da Assistência à Saúde , Acuidade Visual , Campos Visuais/fisiologia , Atividades Cotidianas , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Glaucoma/epidemiologia , Glaucoma/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Morbidade/tendências , Estudos Prospectivos , Qualidade de Vida , Queensland/epidemiologia , Inquéritos e Questionários , Adulto Jovem
12.
BMC Ophthalmol ; 19(1): 179, 2019 Aug 13.
Artigo em Inglês | MEDLINE | ID: mdl-31409322

RESUMO

BACKGROUND: Vogt-Koyanagi-Harada (VKH) disease is a T-cell-mediated autoimmune disorder characterized by bilateral granulomatous panuveitis with various systemic manifestations. Although VKH disease rarely occurs in the pediatric population, the clinical course tends to be aggressive, and the visual prognosis is worse than that in adult patients due to severe ocular complications secondary to recurrent inflammation. CASE PRESENTATION: A 3-year-old girl with probable VKH was referred to Kobe University Hospital. She had severe bilateral panuveitis with posterior synechiae of the iris, marked optic disk swelling, and serous retinal detachment in both eyes, and her best corrected visual acuities (BCVAs) were 20/200 OD and 20/125 OS. A third course of therapy was administered because serous retinal detachment remained after two courses of therapy. She was treated with three courses of high-dose intravenous corticosteroid therapy, followed by slow tapering of oral corticosteroids. Her BCVAs recovered to 20/16 OU, and relapse of ocular inflammation and side effect of treatment were not observed during the 1.5-year follow-up period. CONCLUSIONS: We experienced a pediatric patient with probable VKH disease who was treated with three courses of high-dose intravenous corticosteroid therapy. With the favorable clinical course in our patient, initial treatment with repeated high-dose intravenous corticosteroid therapy might be beneficial in pediatric VKH disease.


Assuntos
Angiofluoresceinografia/métodos , Pressão Intraocular/fisiologia , Metilprednisolona/uso terapêutico , Tomografia de Coerência Óptica/métodos , Síndrome Uveomeningoencefálica/diagnóstico , Acuidade Visual , Pré-Escolar , Feminino , Fundo de Olho , Glucocorticoides/uso terapêutico , Humanos , Oftalmoscopia , Recidiva , Síndrome Uveomeningoencefálica/tratamento farmacológico , Síndrome Uveomeningoencefálica/fisiopatologia
13.
Eur J Ophthalmol ; 29(1_suppl): 22-26, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31282196

RESUMO

INTRODUCTION: Phaco-antigenic glaucoma occurs in less than 1% of cataract surgeries. Managing this rare complication is challenging, especially when there are few documented cases reported. We describe the challenges of managing a case of bilateral phaco-antigenic glaucoma following uncomplicated cataract surgery requiring viscocanalostomy. CASE DESCRIPTION: An 82-year-old atopic lady presented with a 2-day history of painful injected right eye. She was 4 days post left and 8 days post right uncomplicated cataract surgery. On examination, the anterior chambers were deep with no hypopyon. Intraocular pressure was raised at 38 mmHg in the right eye and 24 mmHg in the left eye initially. However, intraocular pressure remained uncontrolled despite maximum medical treatment; she attended A + E six times within 11 days with intraocular pressures of up to 48 mmHg in the right eye and 46 mmHg in the left eye. A vitreous biopsy was reported negative for infective organisms. Eventually, bilateral viscocanalostomies were performed and vision improved to 0.24 logMAR in both eyes with intraocular pressures of 8 mmHg in the right eye and 10 mmHg in the left eye. CONCLUSION: We present a rare presentation of phaco-antigenic glaucoma following an uncomplicated cataract surgical procedure with good results following timely intervention.


Assuntos
Autoantígenos/sangue , Extração de Catarata , Glaucoma/etiologia , Cristalino/imunologia , Complicações Pós-Operatórias , Idoso de 80 Anos ou mais , Anti-Hipertensivos/uso terapêutico , Feminino , Glaucoma/tratamento farmacológico , Glaucoma/imunologia , Humanos , Pressão Intraocular/fisiologia , Tonometria Ocular , Acuidade Visual/fisiologia
14.
Semin Ophthalmol ; 34(6): 451-457, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31348729

RESUMO

Purpose: To determine the clinical manifestations and risk factors of developing strabismus in primary congenital glaucoma (PCG) patients who underwent glaucoma surgery. Methods: A retrospective case-series study of 54 PCG patients who were followed for at least 3 years after glaucoma surgery. The subjects were divided into 2 groups based on the occurrence of strabismus. Age at glaucoma diagnosis and surgery, visual acuity, intraocular pressure, amblyopia, cup-disc ratio, and orthoptic status were compared between the 2 groups. Results: Twenty of 54 patients (37.0%) developed strabismus after glaucoma surgery. The mean ages at the time of glaucoma diagnosis and surgery were 3.2 ± 2.7 months and 3.4 ± 2.8 months in the strabismus group and 24.3 ± 19.1 months and 26.4 ± 18.9 months in the non-strabismus group, respectively (p < .05). In addition, the mean logMAR visual acuities were 0.87 ± 0.38 in the strabismus group and 0.24 ± 0.21 in the non-strabismus group (p < .05). The proportion of patients experiencing amblyopia was 90.0% in the strabismus group. Low visual acuity and young age at glaucoma surgery were significant predictors of developing strabismus. Kaplan-Meier survival analysis demonstrated that the probability of developing strabismus after glaucoma surgery was 50.6% at 10 years post-surgery. Conclusions: PCG patients who developed strabismus after glaucoma surgery were diagnosed with glaucoma and underwent surgery at a younger age, exhibited a worse mean best corrected visual acuity, and exhibited a higher amblyopia incidence than did patients in the non-strabismus group.


Assuntos
Movimentos Oculares/fisiologia , Cirurgia Filtrante/efeitos adversos , Glaucoma/congênito , Pressão Intraocular/fisiologia , Músculos Oculomotores/fisiopatologia , Complicações Pós-Operatórias/etiologia , Estrabismo/etiologia , Pré-Escolar , Feminino , Seguimentos , Glaucoma/fisiopatologia , Glaucoma/cirurgia , Humanos , Incidência , Lactente , Masculino , Complicações Pós-Operatórias/fisiopatologia , Prognóstico , República da Coreia/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Estrabismo/epidemiologia , Estrabismo/fisiopatologia , Fatores de Tempo
15.
Semin Ophthalmol ; 34(6): 446-450, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31361521

RESUMO

Purpose: To evaluate the relationship between visual acuity, visual field and spectral domain optical coherence tomography (OCT) parameters, including retinal nerve fiber layer (RNFL), ganglion cell-internal plexiform layer (GC-IPL) thicknesses, and optic nerve head parameters in patients with severe glaucoma. Material and Methods: Patients with the diagnosis of severe glaucoma were recruited from the data gathered at our glaucoma department. A detailed ophthalmic examination was performed using the Standard Automated Perimetry (the 30-2 SITA standard program was used for VF testing). Cirrus EDI-OCT was used for peripapillary RNFL and GC-IPL thickness measurements. Optic nerve head parameters, including mean cup-to-disc (c/d) ratio, rim area, vertical c/d ratio, cup volume, were also measured by spectral domain OCT. Correlations between these structural parameters and functional parameters (visual acuity, VF parameters) were investigated. Results: Forty-one eyes of 34 patients with severe glaucoma were enrolled in this study. Correlations between BCVA and mean GC-IPL thickness (p = .03), superior GC-IPL thickness (p = .03), inferonasal GC-IPL thickness (p = .01), superonasal GC-IPL thickness (p = .01), superotemporal GC-IPL thickness (p = .04), and rim area (p = .00) were found to be positive statistically significant. There was also a positive statistically significant correlation between MD and inferotemporal GC-IPL thickness (p = .03). Negative statistically significant correlations were found between BCVA and mean c/d ratio (p = .00), vertical c/d ratio (p = .02) and cup volume (p = .00). Discussion: Mean, superior, inferonasal, superonasal, and superotemporal GC-IPL thicknesses and mean c/d ratio, vertical c/d ratio and cup volume were found to be correlated with BCVA in patients with severe glaucoma.


Assuntos
Glaucoma/diagnóstico , Pressão Intraocular/fisiologia , Disco Óptico/patologia , Células Ganglionares da Retina/patologia , Tomografia de Coerência Óptica/métodos , Campos Visuais , Idoso , Idoso de 80 Anos ou mais , Feminino , Glaucoma/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Fibras Nervosas/patologia , Índice de Gravidade de Doença , Vazamento Acidental em Seveso , Acuidade Visual
16.
BMC Ophthalmol ; 19(1): 142, 2019 Jul 08.
Artigo em Inglês | MEDLINE | ID: mdl-31286869

RESUMO

BACKGROUND: This comparative study aimed to demonstrate the differences between swept source OCT (SS-OCT) (1310 nm) and spectral domain OCT (SD-OCT) (840 nm) for the identification and measurement of anterior chamber angle (ACA) structures. METHODS: Sixty seven eyes from 67 healthy subjects underwent ACA imaging at the nasal and temporal sides using SS-OCT and SD-OCT with different wavelength (Tomey, 1310 nm and RTvue, 840 nm). Images were evaluated for the ability to distinguish angle structures including the Schwalbe's line (SL), the Schlemm's canal (SC) and the scleral spur (SS). The length of trabecular meshwork (LTM), the angle-opening distance (AOD500 and AOD750) and the length of Schlemm's canal (LSC) were also measured. RESULTS: The nasal identification rate for SL, SC and SS were 91.04%/89.55%, 50.75%/40.30% and 100.0%/74.63% (SS-OCT/SD-OCT), respectively. The temporal identification rate for SL, SC and SS were 86.57%/91.04%, 68.66%/70.15% and 100.0%/65.67% (SS-OCT/SD-OCT), respectively. Differences between SS-OCT and SD-OCT were found in terms of the visualization of the SS. With respect to the measurements of angle, the evaluation of LTM at the nasal side, LSC at the temporal side and AOD500/750 at both sides showed significant difference between the two devices. However, there existed good correlation between the AOD500/750 measured by SS-OCT and SD-OCT (Spearman's rank correlation coefficient > 0.8, p < 0.000). CONCLUSIONS: SS-OCT displayed a better performance in detecting deeper structures of the angle such as the SS. However, for discriminating structures lying in transparent or semi-transparent tissue such as the SL and the SC, the two devices showed good consistency. Although SS-OCT and SD-OCT demonstrated high correlation for angle measurement (AOD500/750), their agreement was poor.


Assuntos
Segmento Anterior do Olho/diagnóstico por imagem , Glaucoma de Ângulo Fechado/diagnóstico , Glaucoma de Ângulo Aberto/diagnóstico , Pressão Intraocular/fisiologia , Tomografia de Coerência Óptica/métodos , China/epidemiologia , Estudos Transversais , Feminino , Seguimentos , Glaucoma de Ângulo Fechado/epidemiologia , Glaucoma de Ângulo Fechado/fisiopatologia , Glaucoma de Ângulo Aberto/fisiopatologia , Gonioscopia , Voluntários Saudáveis , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Reprodutibilidade dos Testes , Estudos Retrospectivos , Malha Trabecular/diagnóstico por imagem
17.
Semin Ophthalmol ; 34(5): 398-402, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31284800

RESUMO

Purpose: To compare the success rates and safety of transscleral cyclophotocoagulation (TSCPC) for the treatment of refractory glaucoma using the slow coagulation technique and the conventional technique. Methods: A retrospective, interventional case series of 44 patients (44 eyes) who underwent TSCPC using the slow coagulation technique (22 eyes) and conventional technique (22 eyes) in a tertiary hospital was done. The main outcome measures were success and complications. Success was defined as a final intraocular pressure (IOP) between 6 and 21 mmHg with or without IOP lowering medications with the cessation of oral carbonic anhydrase inhibitor at 12 months. Results: Preoperative characteristics were statistically similar with regard to age, sex, laterality, diagnosis, IOP, and the number of glaucoma medications used. Both procedures had similar success rates of 40.9% and 36.3% in the conventional technique group and slow coagulation group, respectively (p = .757). The slow coagulation group had less prolonged anterior chamber inflammation (p = .048). Conclusions: Diode laser TSCPC using the slow coagulation technique is a safe and effective technique for lowering IOP in patients with refractory glaucoma in Chinese eyes.


Assuntos
Glaucoma/cirurgia , Fotocoagulação a Laser/métodos , Procedimentos Cirúrgicos Oftalmológicos , Esclera/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Anti-Hipertensivos/uso terapêutico , Inibidores da Anidrase Carbônica/uso terapêutico , Feminino , Glaucoma/fisiopatologia , Humanos , Pressão Intraocular/fisiologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto Jovem
18.
BMC Ophthalmol ; 19(1): 149, 2019 Jul 12.
Artigo em Inglês | MEDLINE | ID: mdl-31300022

RESUMO

BACKGROUND: The effect of cataract surgery on IOP in patients with primary open-angle glaucoma (POAG) is a subject of debate. We investigated the effect of cataract surgery by phacoemulsification on intraocular pressure (IOP) in patients with medically POAG . METHODS: Seventy eyes of 40 POAG patients undergoing cataract surgery by phacoemulsification were retrospectively evaluated. All patients had their POAG medically controlled without prior glaucoma surgery. Baseline demographics and clinical characteristics were recorded. IOP and the number of glaucoma medications were evaluated before and for 1 year after cataract surgery. We analyzed IOP variations from baseline with a Student t-test for a paired sample. We used a Pearson correlation coefficient and linear regression to study the relation between IOP change from baseline and preoperative characteristics. RESULTS: One year after phacoemulsification, IOP decreased by a mean 1.15 ± 3 mmHg (6.8 ± 18.1%) (P = 0.01) and the number of glaucoma medications remained unchanged with a difference of - 0.1 ± 0.43 (P = 0.09). Higher preoperative IOP was associated with a greater IOP decrease after 1 year of follow-up (P < 0.001). One and 7 days after cataract surgery, 12.9 and 4.2% of the eyes had IOP spikes > 30 mmHg, respectively. One year after cataract surgery, 75.7% of the POAG eyes maintained the same number of glaucoma medications while 17.1% had a decrease and 7.2% of the eyes required adding glaucoma medications. CONCLUSION: Cataract surgery by phacoemulsification in eyes with medically controlled POAG resulted at 1 year in a very small IOP decrease without a change in the number of glaucoma medications. A drop in IOP should not be expected after performing phacoemulsification alone in POAG patients.


Assuntos
Catarata/complicações , Glaucoma de Ângulo Aberto/complicações , Pressão Intraocular/fisiologia , Facoemulsificação , Idoso , Anti-Hipertensivos/uso terapêutico , Feminino , Seguimentos , Glaucoma de Ângulo Aberto/tratamento farmacológico , Glaucoma de Ângulo Aberto/fisiopatologia , Humanos , Implante de Lente Intraocular/métodos , Masculino , Período Pós-Operatório , Estudos Retrospectivos , Fatores de Tempo , Tonometria Ocular , Resultado do Tratamento
19.
Asia Pac J Ophthalmol (Phila) ; 8(3): 229-232, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31165604

RESUMO

PURPOSE: To compare the measurement of intraocular pressure (IOP) of Icare rebound tonometer and Perkins applanation tonometer (PAT) during community eye screening and to assess the agreement between these 2 instruments. DESIGN: A cross-sectional, non-interventional study. METHODS: The IOP measurements by handheld Icare rebound tonometer (Finland) were first performed by a primary care physician. Then the IOP was measured using Perkins Mk3 applanation tonometer (Haag-Streit, UK) by an ophthalmologist who was masked to previous readings from the Icare rebound tonometer. The mean IOP measured by each tonometer was compared. Pearson correlation coefficient was used to explore the correlation between the IOP measurements of the 2 instruments. The level of agreement between them was assessed using the Bland and Altman method. RESULTS: A total of 420 left eyes were examined. The mean age of subjects was 38.6 ± 18.2 years. Approximately 67% of subjects were female. The mean IOP was 16.3 ± 4.0 mm Hg using Icare and 13.4 ± 2.3 mm Hg using PAT. Pearson correlation coefficient showed a moderate positive correlation between the 2 methods (r = +0.524, P < 0.001). Linear regression analysis revealed a slope of 0.28 with R² of 0.255. The mean difference between the 2 methods was 2.90 ± 3.5 mm Hg and the sample t-test revealed a statistically significant mean difference from 0 (P < 0.001). The 95% limits of agreement between the 2 methods were between -9.73 and 3.93 mm Hg. CONCLUSIONS: The handheld Icare rebound tonometer is a reasonably acceptable screening tool in community practices. However, Icare overestimated IOP with a mean of 2.90 mm Hg higher than the PAT. Thus, using Goldmann applanation tonometer as a confirmatory measurement tool of IOP is suggested.


Assuntos
Glaucoma/diagnóstico , Pressão Intraocular/fisiologia , Tonometria Ocular/instrumentação , Seleção Visual/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Desenho de Equipamento , Feminino , Seguimentos , Glaucoma/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Curva ROC , Reprodutibilidade dos Testes , Adulto Jovem
20.
BMC Ophthalmol ; 19(1): 132, 2019 Jun 21.
Artigo em Inglês | MEDLINE | ID: mdl-31226955

RESUMO

BACKGROUND: Although the pathogenesis of glaucoma is not fully understood,an elevated intraocular pressure (IOP) is a major factor contributing to its development and progression. The aim of this study was to investigate the changes in the vessel densities of the macula and optic nerve head (ONH) after an acute elevation in the intraocular pressure (IOP) observed using optical coherence tomography angiography (OCTA). METHODS: This was a prospective comparative study of subjects with narrow anterior chamber angles who underwent laser peripheral iridotomies (LPIs). The IOP was measured before and one hour after the LPI. The retinal vessel densities of the macula and ONH were measured using OCTA at the baseline and one hour after the LPI. RESULTS: A total of 64 eyes of 51 individuals were enrolled in this study, and 58 eyes of 43 individuals finally completed the study with a mean IOP rise of 10.5 ± 7.6 mmHg after the LPI. Based on the magnitude of the rise in the IOP, we divided the subjects into three groups: group A = IOP rise ≤10 mmHg, group B = 10 mmHg < IOP rise ≤20 mmHg, and group C = IOP rise > 20 mmHg. The vessel density did not differ after the acute IOP elevation in either the macular region or papillary region in group A or group B (p > 0.05), but there was a significant difference in group C (p < 0.05). However, when the subjects were not separated into groups, the vessel densities of the ONH and macular region did not differ between the measurements obtained at the baseline and one hour after the LPI (p > 0.05). The correlation existed in peripapillary and macular vessel density (p < 0.05). CONCLUSION: In these subjects with narrow antenior chamber, an acute mild or moderate IOP elevation for one hour after the LPI did not affect the vessel density in the macula or ONH, as examined using OCTA. However, when the IOP rise was greater than 20 mmHg, the macular and papillary vessel density decreased significantly.


Assuntos
Câmara Anterior/patologia , Hipertensão Ocular/patologia , Vasos Retinianos/patologia , Doença Aguda , Idoso , Feminino , Humanos , Pressão Intraocular/fisiologia , Macula Lutea/irrigação sanguínea , Masculino , Pessoa de Meia-Idade , Disco Óptico/irrigação sanguínea , Estudos Prospectivos , Tomografia de Coerência Óptica/métodos
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