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1.
Vestn Oftalmol ; 137(2): 26-33, 2021.
Artigo em Russo | MEDLINE | ID: mdl-33881260

RESUMO

The active exploration of space requires minimizing negative effects induced by weightlessness (microgravity). Risk reduction can be achieved with the use of artificial gravity created by short-radius centrifuge (SRC). Short-radius centrifuge causes redistribution of body liquids towards the caudal portion of the body imitating a vertical human pose. Presently, studying the safety of this prevention method for the human body in general, and for the visual system in particular, is one of the priority tasks of space medicine. PURPOSE: To study the effects of artificial gravity on the perimetry measurements of the eye. MATERIAL AND METHODS: The study included 9 volunteers (men) aged 31.2±6 years (from 25 to 40 years). Each man was subjected to three rotations on SRC. The operative factor in the tests was overloads in the «head-pelvis¼ direction. Rotations were carried out in three different modes with varying maximum overload value at the feet level of up to 2.0; 2.4; 2.9 G. Pulsar-perimetry was carried out before and 1-2 hours after the rotations estimating the mean threshold of retinal photosensitivity Mean Sensitivity (MS), mean loss of sensitivity Mean Defect (MD), square root of Loss Variance (sLV); the Bebie curve; additionally, cluster analysis was performed. RESULTS: Mean threshold of retinal photosensitivity, mean loss of photosensitivity, square root of Loss Variance by Pulsar-perimetry before (MS=22.75 dB; MD= -0.6 dB; sLV=1.5) and after rotations on SRC (in Mode 1: 23.4; -0.2; 1.5, Mode 2: 23.2; -0.4; 1.4 and Mode 3: 23.5; -0.8; 1.4 respectively) did not change significantly. No adverse phenomena were detected in the eyes. CONCLUSIONS: There were no significant changes in the visual fields of the test subjects after rotations in three different modes according to Pulsar-perimetry data, which gives reason to tentatively conclude that using SCR in these modes is safe for the visual sensory system. According to preliminary data, this method can be successfully used to reduce the risk of long-term space flights and prevent unwanted phenomena caused by weightlessness.


Assuntos
Gravidade Alterada , Testes de Campo Visual , Adulto , Olho , Humanos , Masculino , Sensibilidade e Especificidade , Campos Visuais
2.
Indian J Ophthalmol ; 69(4): 989-991, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33727475

RESUMO

Ocular manifestations of COVID-19 are still being studied. Posterior segment involvement in viral entities is either direct viral involvement or a delayed immune response to the antigen. A 22-year-old woman presented with history of perceiving absolute inferior scotoma in the right eye for 4 days and history of fever and sore throat 10 days ago. Fundus examination revealed disc edema and vessel tortuosity. Humphreys Field Analyzer confirmed inferior field defect and Optical Coherence Tomography showed superior, nasal and inferior retinal nerve fiber layer thickening in the right eye. Patient was positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by reverse transcription polymerase chain reaction (RT-PCR) testing. Patient received three doses of injection methylprednisolone over 3 days. There was subjective resolution of scotoma reported 3 weeks posttreatment. We bring forward the first reported case of parainfectious optic neuritis associated with COVID-19.


Assuntos
/diagnóstico , Infecções Oculares Virais/diagnóstico , Papiledema/diagnóstico , Escotoma/diagnóstico , Campos Visuais/fisiologia , /tratamento farmacológico , Infecções Oculares Virais/tratamento farmacológico , Infecções Oculares Virais/virologia , Feminino , Glucocorticoides/uso terapêutico , Humanos , Metilprednisolona/uso terapêutico , Papiledema/tratamento farmacológico , Papiledema/virologia , Escotoma/tratamento farmacológico , Escotoma/virologia , Tomografia de Coerência Óptica , Acuidade Visual , Testes de Campo Visual , Adulto Jovem
3.
Cesk Slov Oftalmol ; 77(1): 22-26, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33740864

RESUMO

AIMS: The aim of the work is to verify the necessity of full-field perimetry test in incipient glaucoma. MATERIAL AND METHODS: The study included group of 16 incipient hypertension glaucoma (HTG group) patients without obvious changes in visual field and control group of 10 patients with normal ocular findings and value 1.0 of visual acuity. In both groups, full-field perimetry test was performed followed by a glaucoma perimetry test (rapid threshold strategy in both cases). Evaluated parameters were pattern defect (PD) and overall defect (OD) using Pearsons correlation coefficient. RESULTS: Strong correlation coefficient between PD (r = 0.74) and OD (r = 0.63) of both perimetry test were found in HTG group. Moderate correlation of PD (r = 0.54) and strong correlation of OD (r = 0.64) in control group. CONCLUSION: Results of the study shows, that expected changes of peripheral visual field will be recorded first in HTG group, but opposite is true. Perimetry glaucoma test is for incipient glaucoma sufficient to document the course and the examination of glaucoma disease.


Assuntos
Glaucoma , Hipertensão , Hipertensão Ocular , Glaucoma/complicações , Glaucoma/diagnóstico , Humanos , Pressão Intraocular , Testes de Campo Visual , Campos Visuais
4.
Arq Bras Oftalmol ; 84(2): 113-120, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33567005

RESUMO

PURPOSE: To compare the use of visual field and/or optical coherence tomography (OCT) combined with color retinography by non-glaucoma specialists for differentiating glaucoma from physiological cupping. METHODS: Eighty patients with glaucoma or physiological cupping (40 of each) were randomized according to the examination used (GI: color retinography, GII: color retinography + visual field, GIII: color retinography + optical coherence tomography, GIV: color retinography + visual field + optical coherence tomography). Twenty non-specialist ophthalmologists diagnosed glaucoma from PowerPoint slide images, without direct patient examination. RESULTS: Inter-examiner agreement was good for GII (ĸ: 0.63; 95%CI, 0.53-0.72), moderate for GIII (ĸ: 0.58; 95%CI, 0.48-0.68) and GIV (ĸ: 0.41; 95%CI, 0.31-0.51), and low for GI (ĸ: 0.30; 95%CI, 0.20-0.39) (p<0.001). Diagnostic accuracy was higher in GIII (15.8 ± 1.82) than GI (12.95 ± 1.46, p<0.001) and higher in GII (16.25 ± 2.02) than GI and GIV (14.10 ± 2.24) (both p<0.001). For glaucoma patients only, diagnostic accuracy in GII and GIII was superior to that in GI and GIV (both p<0.001). Sensitivity and specificity were 59% and 70.5% in GI; 86.5% and 76% in GII, 86.5% and 71.5% in GIII; and 68.5% and 72.5% in GIV, respectively. Accuracy was highest in GII (81.3% [95%CI, 77.1-84.8]), followed by GIII (79% [95%CI, 74.7-82.7]), GIV (70,5% [95%CI, 65.9-74.8]), and GI (64.8% [95%CI, 60.0-69.3]). CONCLUSIONS: Non-glaucoma specialists could not differentiate glaucoma from increased physiological cupping when using color retinography assessment alone. Diagnostic accuracy and inter-rater agreement improved significantly with the addition of visual field or optical coherence tomography. However, the use of both modalities did not improve sensitivity/specificity.


Assuntos
Glaucoma , Tomografia de Coerência Óptica , Glaucoma/diagnóstico por imagem , Humanos , Especialização , Testes de Campo Visual , Campos Visuais
5.
Dis Mon ; 67(5): 101141, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33549309

RESUMO

Diabetic papillitis (used interchangeably with diabetic papillopathy) is a relatively rare ocular manifestation of systemic diabetic disease. Found in both type 1 and type 2 diabetic patients, it manifests as swelling of the optic nerve head in one or both eyes and is considered a diagnosis of exclusion. Signs and symptoms of optic nerve disease are not necessarily present, and there may be spontaneous recovery. The pathogenesis is poorly understood. The following discussion will cover the presentation, diagnosis, treatment, and prognosis of diabetic papillopathy.


Assuntos
Complicações do Diabetes/complicações , Papiledema/diagnóstico , Papiledema/etiologia , Humanos , Papiledema/terapia , Fotografação , Prognóstico , Distúrbios Pupilares/etiologia , Distúrbios Pupilares/fisiopatologia , Tomografia de Coerência Óptica , Acuidade Visual , Testes de Campo Visual
7.
Klin Monbl Augenheilkd ; 238(2): 132-145, 2021 Feb.
Artigo em Inglês, Alemão | MEDLINE | ID: mdl-33578436

RESUMO

The prognosis of going blind is very stressful for patients diagnosed with "glaucoma". Worries and fear of losing independence is a constant mental burden, with secondary risks of depression and social isolation. But stress is not only a result of glaucoma but also a possible cause (risk factor). This should not be surprising, given that chronic stress can trigger "psychosomatic" organ dysfunctions anywhere in the body. Why should the organ "eye" be an exception? Indeed, glaucoma patients often suspect that severe emotional stress caused their visual field loss or "foggy vision". The hypothesis that stress is a possible cause of glaucoma is supported by different observations: (i) acute and chronic stress increases intraocular pressure and (ii) long-term stress can lead to vascular dysregulation of the microcirculation in the eye and brain ("Flammer's syndrome"), leading to partial hypoxia and hypoglycaemia (hypo-metabolism). Even if nerve cells do not die, they may then become inactive ("silent" neurons). (iii) Degenerative changes have been reported in the brain of glaucoma patients, affecting not only anterograde or transsynaptic areas of the central visual pathway, but degeneration is also found (iv) in brain areas involved in emotional appraisal and the physiological regulation of stress hormones. There are also psychological hints indicating that stress is a cause of glaucoma: (v) Glaucoma patients with Flammer's syndrome show typical personality traits that are associated with low stress resilience: they often have cold hands or feet, are ambitious (professionally successful), perfectionistic, obsessive, brooding and worrying a lot. (vi) If stress hormone levels and inflammation parameters are reduced in glaucoma patients by relaxation with meditation, this correlates with normalisation of intraocular pressure, and yet another clue is that (vii) visual field improvements after non-invasive current stimulation therapy, that are known to improve circulation and neuronal synchronisation, are much most effective in patients with stress resilient personalities. An appreciation of stress as a "cause" of glaucoma suggests that in addition to standard therapy (i) stress reduction through relaxation techniques should be recommended (e.g. meditation), and (ii) self-medication compliance should not be induced by kindling anxiety and worries with negative communication ("You will go blind!"), but communication should be positive ("The prognosis is optimistic").


Assuntos
Glaucoma , Humanos , Pressão Intraocular , Tonometria Ocular , Testes de Campo Visual , Vias Visuais
9.
J Glaucoma ; 30(4): 287-292, 2021 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-33428353

RESUMO

PURPOSE: The coronavirus disease 2019 (COVID-19) spread rapidly worldwide, causing a severe outbreak. Because the disease is easily transmitted, face masks are a vital tool to slow the spread. The aim of this study is to investigate the impacts of face mask use on standard automated perimetry (SAP) results in glaucoma patients. MATERIALS AND METHODS: All follow-up glaucoma patients who underwent SAP between May and October 2020 were enrolled in this study. In patients with low test reliability and/or visual field changes, SAP was repeated after repositioning and taping patients' face masks. RESULTS: A total of 127 patients (59 female and 68 male) with a mean age of 59.8±10.3 years were included in the study. While 101 patients (79.5%) wore surgical face masks, 26 patients (20.5%) wore cloth face masks. Low SAP reliability appeared in 23 patients (18.1%), and inferior visual field defects were present in 3 patients (2.4%). The main effects of poorly fitting face masks on SAP reliability were increased fixation losses and false-positive errors (for both, P=0.001). Low SAP reliability was significantly higher in patients wearing cloth face masks than in those wearing surgical face masks (47.8% vs. 9.9%; P=0.0001). The face mask-related fogging of eyeglasses before SAP is a strong predictor of fogging of the trial lenses-related low SAP reliability (odds ratio: 27, 95% confidence interval: 5.48-132.92, P=0.0001). In all repeated SAPs, the patients' reliability parameters improved, and inferior visual field artifacts disappeared. CONCLUSIONS: Unsuitable face masks can cause either visual field artifacts, which may be interpreted as glaucoma progression or low test reliability. Taping the face masks' upper edges is an effective technique to prevent visual field artifacts and obtain good test reliability.


Assuntos
Glaucoma/diagnóstico , Pressão Intraocular , Máscaras/efeitos adversos , Testes de Campo Visual/efeitos adversos , Testes de Campo Visual/métodos , Idoso , Artefatos , Processamento Eletrônico de Dados , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Padrões de Referência , Reprodutibilidade dos Testes , Campos Visuais
10.
J Glaucoma ; 30(3): 219-222, 2021 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-33394847

RESUMO

PRECIS: Designing and demonstrating an experiment that shows the risk of airborne transmission of COVID-19 between patients having visual fields analyzed is low. PURPOSE: The aim was to investigate the possibility of airborne transmission of COVID-19 during Humphrey visual field testing in a real-world scenario. METHODS: A particle counter was placed within the bowl of Humphrey visual field analyzer (HFA) before and after turning on the machine to ascertain the effect of the air current produced by the ventilation system on aerosols. A second experiment was run where the particle counter was placed in the bowl and recorded particulates, in the air, as a 24-2 SITA standard was performed by a mock patient and then again immediately after the patient had moved away. We measured aerosol particle counts sized ≤0.3 µm, >0.3≤0.5 µm, >0.5≤1 µm, >1≤2.5 µm, >2.5≤5 µm, and >5≤10 µm. RESULTS: Particulates of all sizes were shown to be significantly reduced within the bowl after turning the machine on, demonstrating that the air current produced by the HFA pushes air out of the bowl and it cannot stagnate. There was no significant difference in measurement of aerosol while there was a patient performing the test and immediately after they had moved away, suggesting that aerosols breathed out by the patient are not able to remain in suspension in the bowl because of the ventilation current. CONCLUSION: There is no significant difference between aerosol count in the bowl of a HFA before, during and after testing. This suggests the risk of airborne transmission of COVID-19 is low between subsequent patients. This is in keeping with manufacturer's guidance on Humphrey visual field testing.


Assuntos
Aerossóis/efeitos adversos , Transmissão de Doença Infecciosa/prevenção & controle , Hipertensão Ocular/diagnóstico , Testes de Campo Visual/métodos , Campos Visuais/fisiologia , /epidemiologia , Comorbidade , Humanos , Pressão Intraocular/fisiologia , Hipertensão Ocular/epidemiologia , Hipertensão Ocular/fisiopatologia
11.
Curr Opin Ophthalmol ; 32(2): 92-97, 2021 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-33443958

RESUMO

PURPOSE OF REVIEW: Perimetry remains important for the diagnosis and management of glaucoma despite advances in imaging technology. The purpose of this review is to describe advances in the acquisition and analysis of visual field data and highlight novel techniques for performing perimetry. RECENT FINDINGS: Studies have focused on improving the detection of patients at highest risk of severe vision loss and the development of innovative testing strategies that allow for more frequent testing. Artificial intelligence has been utilized in research settings to improve detection and characterization of glaucomatous field damage. Furthermore, tablet-based strategies and virtual reality headsets show promise for glaucoma screening and remote monitoring of patients with glaucoma. SUMMARY: New testing strategies and research findings have improved our ability to identify patients with both paracentral and mid-peripheral visual field progression. New strategies have the potential to make visual field testing more efficient, reliable and accessible for patients with glaucoma.


Assuntos
Glaucoma/diagnóstico , Transtornos da Visão/diagnóstico , Testes de Campo Visual/métodos , Campos Visuais/fisiologia , Inteligência Artificial , Progressão da Doença , Humanos , Transtornos da Visão/fisiopatologia
12.
Curr Opin Ophthalmol ; 32(2): 83-91, 2021 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-33470671

RESUMO

PURPOSE OF REVIEW: The study was undertaken to assess the current importance of clinical examination of the optic nerve head (ONH) in glaucoma management. RECENT FINDINGS: ONH changes in glaucoma are easily assessed with good specificity on examination, whereas imaging has not been able to identify pallor of the neuroretinal rim (NRR), disc hemorrhages, or vascular signs of acquired cupping. Glaucomatous neuropathy in primary open angle glaucoma (POAG) has extensive databases on imaging machines, however, other glaucomas such as primary angle closure glaucoma (PACG), juvenile open angle glaucoma (JOAG), congenital, and secondary glaucomas have been reported to have a significantly different ONH morphology. Clinical evaluation with knowledge of the underlying cause of glaucoma allows easy diagnosis of any abnormality, whereas the absence of an imaging database in such eyes makes diagnosis difficult on optical coherence tomography (OCT) and so forth. In eyes with congenital anomalies and dysplastic discs, clinical examination and history provide better identification of glaucomatous damage. Staging of glaucoma on ONH examination when perimetry is unreliable provides a means of determining the amount of damage and appropriate reduction of intraocular pressure (IOP). SUMMARY: Clinical examination of the ONH is very relevant for screening, diagnosis, staging, and management of all glaucomas, and is irreplaceable in detecting nonglaucomatous causes of ONH cupping and visual field defects similar to those in glaucoma.


Assuntos
Glaucoma/diagnóstico , Disco Óptico/patologia , Doenças do Nervo Óptico/diagnóstico , Exame Físico , Humanos , Pressão Intraocular , Tonometria Ocular , Transtornos da Visão/diagnóstico , Transtornos da Visão/fisiopatologia , Testes de Campo Visual/métodos , Campos Visuais/fisiologia
13.
Medicine (Baltimore) ; 100(2): e24069, 2021 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-33466164

RESUMO

ABSTRACT: To investigate the impact of different types of binocular integrated visual field defects on the quality of life in glaucoma.Ninety-six patients with primary glaucoma were divided into 5 groups with 25, 24, 11, 15, and 21 patients according to types of the binocular integrated visual field (BVF) defects. The criteria for BVF grouping included mild visual field defect in binocular eyes, mild visual field defect in 1 eye and moderate or advanced defect in the other, moderate and non-overlapping visual field defect in both eyes, overlapping and moderate visual field defect in binocular eyes, and severe defect in both eyes, respectively. The visual field (VF) evaluation was based on H-P-A visual field grading system. Visual acuity, visual field tests and Glaucoma Quality of Life-15 Questionnaire (GQL-15) were performed for enrolled patients, and binocular visual field results were integrated. The changes and correlations of the Visual field index values and quality of life scores were compared among the 5 groups. The main factors affecting the quality of life in glaucoma were analyzed by multiple regression analysis.The best binocular integrated visual field index (BVFI) and optimal quality of life were observed in group A. The BVFI of group B was better than that of group C or group D, but the peripheral vision glare and dark adaptation were worse. No significant difference was noted between group C and group D in terms of BVFI. However, the glare and dark adaptation in group C were better than that in group D. The BVFI was the lowest and the quality of life was the worst in group E. In all, BVFI and decibels (dB) values were negatively correlated with GQL-15 scores and positively correlated with patients' quality of life.Binocular integrated visual field accurately reflects the visual function in glaucoma. Higher binocular integrated visual field indices represent a better quality of life for patients with glaucoma. Mild to moderate synchronous or complementary binocular VF defects had a slight effect on the quality of life, while severe and non-compensated VF loss significantly impacts on quality of life in glaucoma patients.


Assuntos
Glaucoma/fisiopatologia , Qualidade de Vida/psicologia , Perfil de Impacto da Doença , Transtornos da Visão/psicologia , Visão Binocular , Idoso , Feminino , Glaucoma/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Transtornos da Visão/etiologia , Acuidade Visual , Testes de Campo Visual , Campos Visuais
17.
BMC Ophthalmol ; 20(1): 490, 2020 Dec 17.
Artigo em Inglês | MEDLINE | ID: mdl-33334311

RESUMO

BACKGROUND: The aim of this retrospective study was to compare the efficacy and safety profile of a single XEN-microstent in different types of primary and secondary open angle glaucoma. METHODS: A single XEN microstent was implanted in patients with primary open-angle glaucoma (POAG), normal-tension glaucoma (NTG), pseudoexfoliation glaucoma (PEX) and secondary glaucoma (Sec.Gl). The intraocular pressure (IOP), the active substances of the applied IOP-lowering drugs, the best corrected visual acuity (BCVA) and the mean deviation (MD) of the perimetry were measured at baseline and at regular follow-ups, scheduled at 2 days and 1, 3, 6 and 12 months after surgery. RESULTS: 153 eyes were included in this analysis. 113 eyes were affected by POAG (74%), 5 eyes by NTG (3%), 22 eyes by PEX (14%) and 13 eyes by Sec. Gl (9%). Mean IOP decreased in all treatment groups during the 12 months of follow-up (complete group: 23.9 ± 7.4 to 15.4 ± 5.1 mmHg (p < 0.01); POAG: 22.8 ± 6.5 to 15.1 ± 4.6 mmHg (p < 0.01); NTG: 16.6 ± 3.4 to 11.6 ± 2.2 mmHg (p < 0.05); PEX: 28.0 ± 7.9 to 17.1 ± 6.6 mmHg (p < 0.01); Sec.Gl: 28.9 ± 13.9 to 15.5 ± 6.9 mmHg (p < 0.05)). In the 153 eyes the average number of IOP-lowering drugs applied decreased from 2.6 ± 1.2 to 0.8 ± 1.3 12 months after surgery (p < 0.01). BCVA and mean deviation of automated standard perimetry remained stable in all groups during follow-up. CONCLUSION: As in eyes suffering from POAG, IOP and number of IOP-lowering drugs applied can be effectively reduced by XEN implantation in eyes suffering from NTG, PEX and secondary glaucoma while leaving BCVA and visual field unchanged. TRIAL REGISTRATION: Trial was registered at DRKS (registration number: DRKS00020800 , Registered 25.February 2020 - Retrospectively registered).


Assuntos
Implantes para Drenagem de Glaucoma , Glaucoma de Ângulo Aberto/cirurgia , Stents , Idoso , Idoso de 80 Anos ou mais , Anti-Hipertensivos/administração & dosagem , Feminino , Seguimentos , Glaucoma de Ângulo Aberto/fisiopatologia , Humanos , Pressão Intraocular/efeitos dos fármacos , Pressão Intraocular/fisiologia , Masculino , Pessoa de Meia-Idade , Implantação de Prótese , Estudos Retrospectivos , Tonometria Ocular , Resultado do Tratamento , Acuidade Visual/fisiologia , Testes de Campo Visual , Campos Visuais/fisiologia
18.
JAMA Netw Open ; 3(12): e2030824, 2020 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-33351088

RESUMO

Importance: Mild traumatic brain injury (TBI) may predispose individuals to progressive neurodegeneration. Objective: To identify evidence of neurodegeneration through longitudinal evaluation of changes in retinal layer thickness using optical coherence tomography in veterans with a history of mild TBI. Design, Setting, and Participants: This longitudinal cohort study evaluated veterans who were receiving services at the Minneapolis Veterans Affairs Health Care System. Symptomatic or mild TBI was diagnosed according to the Mayo TBI Severity Classification System. Participants in the age-matched control group had no history of TBI. Participants with any history or evidence of retinal or optic nerve disease that could affect retinal thickness were excluded. Data analysis was performed from July 2019 to February 2020. Exposures: The presence and severity of mild TBI were determined through consensus review of self-report responses during the Minnesota Blast Exposure Screening Tool semistructured interview. Main Outcomes and Measures: Change over time of retinal nerve fiber layer (RNFL) thickness. Results: A total of 139 veterans (117 men [84%]; mean [SD] age, 49.9 [11.1] years) were included in the study, 69 in the TBI group and 70 in the control group. Veterans with mild TBI showed significantly greater RNFL thinning compared with controls (mean [SE] RNFL slope, -1.47 [0.24] µm/y vs -0.31 [0.32] µm/y; F1,122 = 8.42; P = .004; Cohen d = 0.52). Functionally, veterans with mild TBI showed greater declines in visual field mean deviation (mean [SE] slope, -0.09 [0.14] dB/y vs 0.46 [0.23] dB/y; F1,122 = 4.08; P = .046; Cohen d = 0.36) and pattern standard deviation (mean [SE] slope, 0.09 [0.06] dB/y vs -0.10 [0.07] dB/y; F1,122 = 4.78; P = .03; Cohen d = 0.39) and high spatial frequency (12 cycles/degree) contrast sensitivity compared with controls. Cognitively, there was a significantly greater decrease in the number of errors over time during the Groton Maze Learning Test (GMLT) in controls compared with veterans with mild TBI (mean [SE] slope, -9.30 [1.48] errors/y vs -5.23 [1.24] errors/y; F1,127 = 4.43; P = .04; Cohen d = 0.37). RNFL tissue loss was significantly correlated with both worsening performance on the GMLT over time (Spearman ρ = -0.20; P = .03) and mild TBI severity (Spearman ρ = -0.25; P = .006). The more severe the mild TBI (larger Minnesota Blast Exposure Screening Tool severity score), the faster the reduction in RNFL thickness (ie, the more negative the slope) across time. Conclusions and Relevance: This cohort study found longitudinal evidence for significant, progressive neural degeneration over time in veterans with mild TBI, as indicated by greater RNFL tissue loss in patients with mild TBI vs controls, as well as measures of function. These results suggest that these longitudinal measures may be useful biomarkers of neurodegeneration. Changes in this biomarker may provide early detection of subsequent cognitive and functional deficits that may impact veterans' independence and need for care.


Assuntos
Concussão Encefálica , Cognição , Doenças Neurodegenerativas , Testes Neuropsicológicos/estatística & dados numéricos , Tomografia de Coerência Óptica/métodos , Testes de Campo Visual , Concussão Encefálica/complicações , Concussão Encefálica/fisiopatologia , Doença Crônica , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Doenças Neurodegenerativas/diagnóstico , Doenças Neurodegenerativas/etiologia , Doenças Neurodegenerativas/psicologia , Estados Unidos/epidemiologia , Saúde dos Veteranos/estatística & dados numéricos , Testes de Campo Visual/métodos , Testes de Campo Visual/estatística & dados numéricos
19.
BMJ Case Rep ; 13(12)2020 Dec 22.
Artigo em Inglês | MEDLINE | ID: mdl-33370961

RESUMO

Antitumour necrosis factor alpha agents are important treatments in many inflammatory conditions including rheumatoid arthritis, psoriatic arthritis and the inflammatory bowel diseases. However, there have been case reports of optic neuritis and other demyelinating diseases as complications of these agents. This case report presents a patient with ulcerative colitis on infliximab who presented with sudden onset mono-ocular visual field loss and highlights the diagnosis and management of infliximab-induced optic neuritis.


Assuntos
Cegueira/imunologia , Colite Ulcerativa/tratamento farmacológico , Fármacos Gastrointestinais/efeitos adversos , Infliximab/efeitos adversos , Neurite Óptica/imunologia , Anticorpos Monoclonais Humanizados/uso terapêutico , Cegueira/diagnóstico , Cegueira/tratamento farmacológico , Colite Ulcerativa/imunologia , Substituição de Medicamentos , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Nervo Óptico/diagnóstico por imagem , Nervo Óptico/efeitos dos fármacos , Nervo Óptico/imunologia , Neurite Óptica/complicações , Neurite Óptica/diagnóstico , Neurite Óptica/tratamento farmacológico , Prednisolona/uso terapêutico , Tomografia de Coerência Óptica , Fator de Necrose Tumoral alfa/antagonistas & inibidores , Fator de Necrose Tumoral alfa/imunologia , Acuidade Visual , Testes de Campo Visual , Campos Visuais
20.
Medicine (Baltimore) ; 99(50): e23565, 2020 Dec 11.
Artigo em Inglês | MEDLINE | ID: mdl-33327313

RESUMO

The aim of this study was to evaluate the association between dipping status of blood pressure (BP), visual field defects (VFDs), and retinal nerve fiber layer (RNFL) thickness in patients with normotensive glaucoma (NTG). Our University echocardiography, electrocardiogram, 24-hour BP monitor and glaucoma database were reviewed from 2016 to 2018 to identify patients with NTG and hypertension (HTN). These NTG patients were followed for a mean 26.4 ±â€Š13.6 months and were divided into 2 groups according to the absence or presence of VFDs. Among the 110 patients with NTG, 55 (50%) patients had VFDs. There were no differences of baseline characteristics between 2 groups. In univariate analysis, extreme dipper status at night in the 24-hour BP monitoring, HTN, age, diabetes mellitus, and hyperlipidemia were significantly associated with VFDs. In multivariate analysis, extreme dipper status at night in the 24-hour BP monitoring (odds ratio [OR] 4.094; P = .045) and HTN (OR 2.368; P = .048) were independent risk factors for VFDs at 2-year follow-up. Moreover, the RNFL thickness was thinner in NTG patients with VFDs (P < .001). VFDs group had more increased fluctuation of systolic and diastolic BP in 24-hour BP monitoring and that the extreme dipper status at night in the 24-hour BP monitoring and HTN itself were also associated with higher incidence of VFDs and thinning changes of the RNFL in patients with NTG, suggesting that more intensive medical therapy with close clinical follow-up will be required for these patients.


Assuntos
Glaucoma/complicações , Hipotensão/complicações , Neurônios Retinianos/patologia , Campos Visuais , Pressão Sanguínea/fisiologia , Ecocardiografia , Feminino , Glaucoma/patologia , Glaucoma/fisiopatologia , Humanos , Hipotensão/patologia , Hipotensão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Tomografia de Coerência Óptica , Testes de Campo Visual
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