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PURPOSE: To report a series of patients who developed punctal stenosis secondary to the use of topical netarsudil 0.02% for treatment of glaucoma. DESIGN: Case series. PARTICIPANTS: Patients using topical netarsudil for management of glaucoma and noted to have punctal stenosis ipsilateral to the eye(s) being treated with netarsudil were included. METHODS: Each enrolled patient's chart was reviewed, and alternative causes of punctal stenosis were sought. Photographs were obtained to document punctal stenosis for some patients. MAIN OUTCOME MEASURES: Presence of punctal stenosis after topical netarsudil use and resolution of punctal stenosis after cessation of therapy. RESULTS: Sixteen patients had punctal stenosis; 13 developed unilateral punctal stenosis while using netarsudil unilaterally, and 3 patients developed bilateral punctal stenosis with bilateral use. Time from initiation of netarsudil to recognition of symptoms or documentation of punctal stenosis ranged from 2 to 35 months (median, 12; mean, 14.0 ± 8.7 months). Thirteen patients endorsed tearing, but 2 had no symptoms. Ectropion was seen in 1 eye. Corneal verticillata was noted in 14 patients (87.5%). In 8 cases, netarsudil was discontinued, and the punctal stenosis was reversed, with resolution of associated symptoms. CONCLUSIONS: Netarsudil use can lead to the development of reversible punctal stenosis. This inflammation-mediated stenosis may cause tearing and associated symptoms and may be of sufficient severity to necessitate discontinuation of treatment. In this case series, all patients who discontinued treatment had reversal of their punctal stenosis and associated symptoms.
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Doenças Palpebrais , Glaucoma , Obstrução dos Ductos Lacrimais , Benzoatos , Constrição Patológica/complicações , Doenças Palpebrais/complicações , Glaucoma/complicações , Humanos , Obstrução dos Ductos Lacrimais/induzido quimicamente , Obstrução dos Ductos Lacrimais/diagnóstico , beta-Alanina/análogos & derivadosRESUMO
A 90-year-old woman presented with 1-year history of right-sided progressive proptosis, neovascular glaucoma, blindness, and worsening ocular pain. No funduscopic examination was possible because of a corneal opacity. Head CT scan without contrast demonstrated a heterogeneous 4.1 cm (anterior-posterior) by 1.7 cm (transverse) cylindrical mass arising in the right optic nerve and extending from the retrobulbar globe to the optic canal. She underwent palliative enucleation with subtotal resection of the orbital optic nerve and tumor. Pathological examination showed effacement of the optic nerve by an infiltrative high-grade glial neoplasm with biphasic sarcomeric differentiation. Invasion into the uvea and retina was present. The neoplasm was negative for melan-A, HMB45, tyrosinase, synaptophysin, smooth muscle actin, and epithelial membrane antigen. The glioma had strongly intense, but patchy immunopositivity for glial fibrillary acidic protein. Multiple foci of neoplastic cells had pericellular reticulin staining. The overall features were diagnostic of a gliosarcoma (World Health Organization grade IV) of the optic nerve. Postoperative MRI demonstrated postsurgical changes and residual gliosarcoma with extension into the optic chiasm. The patient died 2 and a half months after her enucleation surgery at her nursing home. Autopsy was unavailable due to the caregiver wishes, making a definitive cause of death unknown. Gliosarcoma is a rare variant of glioblastoma, and this is the first documented case presenting as a primary neoplasm of the optic nerve.
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Gliossarcoma/diagnóstico , Neoplasias do Nervo Óptico/diagnóstico , Nervo Óptico/diagnóstico por imagem , Idoso de 80 Anos ou mais , Evolução Fatal , Feminino , Humanos , Imageamento por Ressonância Magnética , Glioma do Nervo Óptico/diagnóstico , Tomografia Computadorizada por Raios XRESUMO
BACKGROUND: One barrier to patient adherence with chronic topical glaucoma treatment is an inadequate amount of medication available between prescription refills. We examined the self-reported prevalence of early exhaustion of glaucoma eye drops prior to a scheduled refill, and associated risk factors. METHODS: This cross-sectional survey was performed at a University-based clinical practice. Glaucoma patients at the University of Washington who were experienced with eye drop application and were on a steady regimen of self-administered glaucoma drops in both eyes took a survey at the time of clinic examination. The main outcome measure was self-reported early eye drop bottle exhaustion. RESULTS: 236 patients were eligible and chose to participate. In general, patients included were relatively healthy (mean 2.3 comorbid medical conditions). Sixty patients (25.4%) reported any problem with early exhaustion of eye drop bottles, and this was associated with visual acuity ≤ 20/70 in the better eye (P = .049). Twelve patients (5.1%) reported that they "often" (5-7 times per year), "usually" (8-11 times per year) or "always" ran out of eye drops prior to a scheduled refill. Patients affected by this higher level (≥ 5 times yearly) of eye drop bottle exhaustion were more likely to have poor visual acuity in their worse eye ≤ 20/70 (P = .015) and had significantly lower worse-eye logMAR (P = .043). CONCLUSIONS: Self-reported early glaucoma bottle exhaustion regularly affected 5% of patients in our population and 25% reported early exhaustion at least once; the main risk factor was poor vision in at least one eye. These results may not be generalizable to a broad patient population, or to those inexperienced with eye drop self-administration. However, this pilot study compels further evaluation and consideration of early eye drop bottle exhaustion in glaucoma patients.
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Anti-Hipertensivos/administração & dosagem , Glaucoma/epidemiologia , Autorrelato , Idoso , Estudos Transversais , Feminino , Seguimentos , Glaucoma/tratamento farmacológico , Humanos , Masculino , Adesão à Medicação , Soluções Oftálmicas , Projetos Piloto , Prevalência , Estudos Retrospectivos , Fatores de Risco , Autoadministração , Inquéritos e Questionários , Fatores de Tempo , Acuidade Visual , Washington/epidemiologiaRESUMO
The sclera plays an important role in the structural integrity of the eye. However, as myopia progresses, the elongation of the eyeball exerts stretching forces on the posterior sclera, which typically happens in conjunction with scleral remodeling that causes rigidity loss. These biomechanical alterations can cause localized eyeball deformation and vision impairment. Therefore, monitoring scleral rigidity is clinically important for the management and risk assessment of myopia. In this study, we propose fundus pulsation optical coherence elastography (FP-OCE) to characterize posterior scleral rigidity in living humans. This methodology is based on a choroidal pulsation model, where the scleral rigidity is inversely associated with the choroidal max strain obtained through phase-sensitive optical coherence tomography (PhS-OCT) measurement of choroidal deformation and thickness. Using FP-OCE, we conducted a pilot clinical study to explore the relationship between choroidal strain and myopia severity. The results revealed a significant increase in choroidal max strain in pathologic myopia, indicating a critical threshold beyond which scleral rigidity decreases significantly. Our findings offer a potential new method for monitoring myopia progression and evaluating therapies that alter scleral mechanical properties.
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OBJECTIVE: Thoracic Epidural Analgesia (TEA) was compared with ultrasound-guided bilateral erector spinae plane (ESP) block in aorto-femoral arterial bypass surgery for analgesic efficacy, hemodynamic effects, and pulmonary rehabilitation. DESIGN: Prospective randomized. SETTING: Tertiary care centre. PARTICIPANTS: Adult patients, who were scheduled for elective aorto-femoral arterial bypass surgery. INTERVENTIONS: It was a prospective pilot study enrolling 20 adult patients who were randomized to group A (ESP block = 10) and group B (TEA = 10). Monitoring of heart rate (HR) and mean arterial pressure (MAP) and pain assessment at rest and deep breathing using visual analog scale (VAS) were done till 48-h post-extubation. Rescue analgesic requirement, Incentive spirometry, oxygenation, duration of ventilation and stay in Intensive Care Unit (ICU) were reported as outcome measures. Statistical analysis was performed using unpaired Student T-test or Mann-Whitney U test. A value of P < 0.05 was considered significant. RESULTS: HR was lower in group B than group A at 1 and 2 h post- surgery and at 0.5, 16, 20, and 32 h post-extubation (P < 0.05). MAP were lower in group B than A at 60, 90, 120, 150, 180, 210, 240, 270 minutes and at 0 hour post-surgery and at 4 hours, every 4 hours till 32 hours post-extubation (P < 0.05). Intraoperative midazolam and fentanyl consumption, ventilatory hours, VAS at rest, incentive spirometry, oxygenation, and ICU stay were comparable between the two groups. VAS during deep breathing was more in group A than B at 0.5, 4 hours and every 4 hours till 44 hours post-extubation. The time to receive the first rescue analgesia was shorter in group A than B (P < 0.05). CONCLUSION: Both ESP block and TEA provided comparable analgesia at rest. Further studies with larger sample size are required to evaluate whether ESP block could be an alternative to TEA in aorto-femoral arterial bypass surgery.
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Analgesia Epidural , Bloqueio Nervoso , Adulto , Humanos , Dor Pós-Operatória/tratamento farmacológico , Projetos Piloto , Estudos Prospectivos , Ultrassonografia de IntervençãoRESUMO
Importance: Create validated criteria to identify orbital fracture patients at higher risk for significant ocular injuries. Objective: Determine history and physical examination findings in orbital fracture patients who are associated with ocular injury and warrant urgent assessment by an ophthalmologist. Design, Setting, and Participants: Retrospective chart review of 535 adult orbital fracture patients evaluated at a Level I emergency department between 2014 and 2017, without prior history of orbital fracture, ocular injury, or ocular/orbital surgery. Main Outcomes and Measure: Presence of ocular injury. Results: In total, 195 (36%) patients had an ocular injury. Those with and without ocular injury were compared in a multivariate logistic regression model including demographics, fracture characteristics, injury mechanism, and physical examination findings. Visual acuity change, radiographic retrobulbar hemorrhage, abnormal pupillary reaction, and inability to open the injured eye all had significant associations with ocular injury when other findings were controlled. Conclusion: This study shows a significant association between ocular injury and visual acuity change, retrobulbar hemorrhage, abnormal pupillary reaction, and inability to open the injured eye. These factors can help triage when to obtain an urgent ophthalmology consult.
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BACKGROUND/PURPOSE: To present a novel case of paracentral acute middle maculopathy associated with bilateral optic disk swelling. METHODS: Retrospective case report. RESULTS: A 67-year-old woman presented with sudden onset of central vision loss and subsequent bilateral optic disk edema, retinal vessel attenuation, and anterior uveitis. Cerebrospinal fluid analysis showed signs of inflammation. Spectral domain optical coherence tomography demonstrated the pathognomonic hyperreflectivity of the middle retinal layers consistent with paracentral acute middle maculopathy. Swept-source optical coherence tomography angiography with custom vessel analysis demonstrated a 18.3% decrease in the deep retinal vascular density and 2.4 times increase in absent flow area in the affected eye compared with the fellow eye. CONCLUSION: This case demonstrates a novel association between paracentral acute middle maculopathy and bilateral optic disk swelling secondary to central nervous system inflammation and possible infection. Although spectral domain optical coherence tomography is valuable in detecting paracentral acute middle maculopathy, optical coherence tomography angiography with vessel analysis can provide additional insight into the disease mechanism.
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Macula Lutea/patologia , Meningite/complicações , Disco Óptico/patologia , Papiledema/etiologia , Doenças Retinianas/etiologia , Doença Aguda , Idoso , Feminino , Angiofluoresceinografia/métodos , Fundo de Olho , Humanos , Imageamento por Ressonância Magnética , Meningite/diagnóstico , Papiledema/diagnóstico , Doenças Retinianas/diagnóstico , Tomografia de Coerência Óptica/métodosRESUMO
Background: Quantifying diplopia to determine management and track outcomes for orbital fracture patients is vital for standardization between visits, physicians, and coordination among the multiple specialties that manage these patients. However, standardization is challenging, as diplopia is often reported subjectively. This study sought to describe the utility of the digital Hess screen in patients with orbital fractures compared with a control group. Materials and Methods: A prospective pilot study was designed in which adult patients who presented with orbital fractures between November 2017 and January 2019 without prior history of orbital pathology were recruited. Subjects underwent digital Hess screen testing, in which they wore anaglyph glasses and aligned targets on a computer screen to quantify static eye alignment. The degree of any eye misalignment was analyzed and compared with controls. Results: Ninety-one patients and 35 controls were enrolled. All participants were able to complete the digital Hess screen. Average cumulative deviation score of orbital fracture patients within 1 month of injury was 0.65°, compared with 0.28° in controls. This was a statistically significant difference (p < 0.01, 95% confidence interval -0.18 to 0.18). Conclusion: The Hess screen has been used to quantify phoria as a correlate of eye alignment and diplopia, but older versions were cumbersome and difficult to analyze. This study is the first to report on using the digital Hess screen to quantify phoria in orbital fracture patients and provides a more concise and standardized means to track clinical and surgical outcomes of eye alignment.
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Diplopia/diagnóstico , Diplopia/etiologia , Programas de Rastreamento/métodos , Fraturas Orbitárias/complicações , Adulto , Estudos de Casos e Controles , Movimentos Oculares , Feminino , Humanos , Masculino , Projetos Piloto , Estudos Prospectivos , WashingtonRESUMO
PURPOSE: To investigate the relationships between global and sectoral macular vascular microcirculation parameters in the ganglion cell-inner plexiform layer (GCIPL) assessed by optical coherence tomography angiography (OCTA), and global and sectoral visual field (VF) central mean sensitivity (CMS) assessed by standard automated perimetry. METHODS: Fifty-four eyes with open angle glaucoma were scanned using a swept-source OCTA (Plex Elite 9000, Zeiss, Dublin, CA) and macular vascular microcirculation was measured by calculating the overall flux and vessel area density (VAD) over the entire 6mm x 6mm area, excluding large retinal vessels. Central 10-degree VF CMS was calculated based on 24-2 VF. Pearson correlation was used to investigate the correlation between global and sectoral OCTA parameters and global and sectoral VF CMS. RESULTS: Both global GCIPL flux and VAD were significantly correlated with VF CMS (p<0.001). For the sectoral analysis, sectoral VAD was significantly correlated with sectoral VF CMS in all comparisons except for the inferonasal VF CMS with supero-temporal (ST) GCIPL VAD (p = 0.097). Although highest correlation was observed for both ST VF CMS with inferior GCIPL VAD and infero-temporal VF CMS with superior GCIPL VAD (r = 0.683, p<0.001), there was no significant difference in correlation when compared to the global VAD and other sectors' correlation coefficients (p≥ 0.091), except for the ST GCIPL VAD (p = 0.001). CONCLUSIONS: Global and sectoral macular vascular microcirculation in the GCIPL, as determined by OCTA, was significantly correlated with global and sectoral VF CMS in glaucomatous patients. OCTA can aid in the understanding of the structure-function relationships of the macular region.
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Glaucoma de Ângulo Aberto/fisiopatologia , Macula Lutea/irrigação sanguínea , Microcirculação , Células Ganglionares da Retina/patologia , Idoso , Idoso de 80 Anos ou mais , Glaucoma de Ângulo Aberto/diagnóstico por imagem , Glaucoma de Ângulo Aberto/patologia , Humanos , Macula Lutea/patologia , Pessoa de Meia-Idade , Estudos Prospectivos , Tomografia de Coerência Óptica , Testes de Campo Visual , Campos VisuaisRESUMO
PRéCIS:: We found no significant differences in peripapillary and macula microcirculation blood flow metrics in eyes with open-angle glaucoma of African descent (AD) and European descent (ED) as detected by optical coherence tomography angiography (OCTA). PURPOSE: The purpose of this study was to investigate the peripapillary retinal nerve fiber layer (RNFL) and macular vascular microcirculation in subjects of AD and ED with open-angle glaucoma using OCTA. PATIENTS AND METHODS: One eye from each subject was scanned using AngioPlex OCTA system covering both a 6×6 mm scanning area centered at the optic nerve head and at the foveola. Peripapillary RNFL and macular microcirculation were measured by calculating the overall flux and vessel area density excluding the large retinal vessels. Two-sample, independent t tests were used to compare the OCTA metrics between AD and ED eyes. Linear regression models were used to investigate the correlation between OCTA metrics and structural and functional parameters. RESULTS: Twenty-eight eyes of AD and 56 eyes of ED were included in the study. There was no significant difference in age, sex, hypertension, antihypertensive medications, diabetes, systolic and diastolic blood pressure, mean ocular perfusion pressure, RNFL thickness and visual field (VF) mean deviation and VF pattern standard deviation (P≥0.054) between AD and ED eyes included. Both groups had similar OCTA blood flow metrics (P≥0.161). OCTA blood flow metrics were significantly correlated with VF mean deviation (r≥0.466), VF pattern standard deviation (r≤-0.366) and RNFL thickness (r≥0.333). CONCLUSIONS: No significant differences were found in peripapillary and macular microcirculation detected by OCTA between AD and ED glaucomatous eyes. Peripapillary and macular microcirculation were significantly correlated with disease severity in AD and ED glaucomatous eyes.
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Negro ou Afro-Americano/etnologia , Glaucoma de Ângulo Aberto/etnologia , Glaucoma de Ângulo Aberto/fisiopatologia , Microcirculação/fisiologia , Disco Óptico/irrigação sanguínea , Vasos Retinianos/fisiologia , População Branca/etnologia , Idoso , Pressão Sanguínea/fisiologia , Feminino , Angiofluoresceinografia , Fóvea Central , Humanos , Pressão Intraocular/fisiologia , Masculino , Pessoa de Meia-Idade , Fibras Nervosas/patologia , Células Ganglionares da Retina/patologia , Tomografia de Coerência Óptica , Campos Visuais/fisiologiaRESUMO
PRECIS: We found significant differences in macular vascular microcirculation between normal and glaucomatous eyes using optical coherence tomography angiography (OCTA). Macular vascular microcirculation changes also showed significant correlations with visual field (VF) severity classification systems. PURPOSE: To correlate VF severity defined by different classification systems and macular vascular microcirculation in eyes with glaucoma using OCTA. PATIENTS AND METHODS: Twenty normal and 58 open-angle glaucoma (OAG) eyes were scanned using a swept-source OCTA (Plex Elite 9000) and macular vascular microcirculation was measured by calculating the overall blood flux index (BFI) and vessel area density (VAD) over the entire 6×6 mm area excluding the big retinal vessels. Glaucomatous eyes were staged into severity groups based on 4 VF severity classifications: Hodapp-Parrish-Anderson scale, Glaucoma Severity Staging system, ICD-10 glaucoma staging definitions, and VF mean deviation. Central 10-degree VF mean sensitivity (CMS) was calculated based on 24-2 VF. One-way analysis of variance was used to analyze the differences and correlation between macular vascular microcirculation and other clinical parameters. RESULTS: Glaucomatous eyes had significantly lower ganglion cell and inner plexiform layer BFI and VAD (P<0.0001) compared with normal eyes. In OAG patients, BFI and VAD were significantly higher in mild OAG compared with severe OAG with all VF disease severity classification systems (P<0.001). Glaucoma Severity Staging had the highest correlation with changes in macular vascular microcirculation metrics (r=0.734 for BFI; r=0.647 for VAD) and VF CMS had highest correlation with macular vascular microcirculation metrics (r=0.887 for BFI; r=0.903 for VAD). CONCLUSION: Macular vascular microcirculation metrics detected by OCTA correlate with disease severity in glaucomatous eyes. VF CMS, calculated from only 12 tested central 10-degree points, correlated best with macular OCTA.
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Glaucoma de Ângulo Aberto/fisiopatologia , Disco Óptico/irrigação sanguínea , Vasos Retinianos/fisiopatologia , Transtornos da Visão/fisiopatologia , Campos Visuais/fisiologia , Idoso , Idoso de 80 Anos ou mais , Algoritmos , Pressão Sanguínea/fisiologia , Feminino , Angiofluoresceinografia/métodos , Glaucoma de Ângulo Aberto/diagnóstico por imagem , Humanos , Pressão Intraocular/fisiologia , Masculino , Microcirculação/fisiologia , Pessoa de Meia-Idade , Fibras Nervosas/patologia , Células Ganglionares da Retina/patologia , Tomografia de Coerência Óptica/métodosRESUMO
PURPOSE: This study evaluates the radiographic appearance of lacrimal gland tissue after placement of a glaucoma drainage implant (GDI) to characterize the impact of the device on the gland's imaging patterns. METHODS: We performed retrospective chart review of departmental records at two urban academic medical centers, which were systematically searched using procedure codes to identify adult glaucoma patients who underwent unilateral superotemporal GDI from January 1995 to December 2015. Radiology records were cross-checked to identify the subset of patients who underwent postoperative orbital CT or MRI. Chart review collected data on glaucoma diagnosis, management, examination findings, and clinical complaints. Imaging studies were reviewed for orbital changes using qualitative assessment of the radiographic appearances and computer-guided calculations to quantify asymmetries. RESULTS: A review of all eye operations in the inclusion period identified 315 patients with GDI, 13 of whom were eligible for inclusion. Elapsed time from device placement to imaging averaged 41.9 months, and the average clinical follow-up was 56.4 months. Radiographic lacrimal gland changes were appreciable in 69% (9 of 13) of patients, most commonly with posterior displacement and flattening of the gland (7 of 13). ImageJ analysis revealed significantly smaller lacrimal glands in orbits with GDI (P = 0.04). No clear correlation was found between gland changes and clinical dry eye symptoms. CONCLUSION: GDI placement was associated with radiographically-appreciable lacrimal gland changes in two-thirds of patients, with changes occurring in a predictable pattern of lacrimal gland flattening, posteriorization, and volume loss. Radiographic changes correlated with clinical symptoms in few patients.
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PURPOSE: To evaluate noncompliance with follow-up in normal-tension glaucoma (NTG) suspects. DESIGN: Retrospective cohort study. METHODS: We reviewed 203 patient charts at a university eye clinic, identified as NTG suspects from a database of optic disk photographs. Noncompliance was defined as less than one year of follow-up and/or fewer than two completed visual field (VF) tests. RESULTS: Twenty-two patients (11%) were excluded because at least two VF tests were not ordered. The 181 patients analyzed included 45 (25%) non-Whites and 16 (9%) non-English speakers. Eighty-three patients (46%) were noncompliant. These patients were significantly younger (50.5 +/- 15.0 years vs 55.1 +/- 12.8 years; P = .028), were more likely to speak English (P = .023), and were more likely to have no or unknown health insurance (P < .001). CONCLUSIONS: Almost half of NTG suspects lacked appropriate follow-up. Lack of health insurance may be a significant barrier to compliance with follow-up in this population.
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Glaucoma de Ângulo Aberto/terapia , Recusa do Paciente ao Tratamento/estatística & dados numéricos , Competência Clínica , Progressão da Doença , Feminino , Seguimentos , Glaucoma de Ângulo Aberto/diagnóstico , Humanos , Pressão Intraocular , Masculino , Pessoa de Meia-Idade , Visita a Consultório Médico/tendências , Disco Óptico/patologia , Educação de Pacientes como Assunto , Relações Médico-Paciente , Estudos Retrospectivos , Fatores de Risco , Testes de Campo Visual , Campos VisuaisRESUMO
PURPOSE: To produce an internationally valid tool to assess skill in performing trabeculectomy surgery. METHODS: A panel of 5 experts developed a tool for assessing trabeculectomy surgery by using a modified Dreyfus scale of skill acquisition and providing descriptors for each level of skill for each category. The tool was then reviewed by a panel of 10 international content experts for their constructive comments, which were incorporated into the final rubric tool. RESULTS: A final rubric, incorporating the suggestions of the international panel, published here as the ICO-OSCAR: Trabeculectomy. CONCLUSIONS: The tool ICO-OSCAR: Trabeculectomy has content and face validity. It can be used internationally to assess trabeculectomy surgery skill. Predictive and construct validity, and reliability are yet to be determined.
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Competência Clínica/normas , Educação de Pós-Graduação em Medicina/normas , Avaliação Educacional/normas , Internato e Residência , Oftalmologia/educação , Trabeculectomia/educação , Glaucoma/cirurgia , Humanos , Pressão Intraocular , Reprodutibilidade dos TestesRESUMO
Importance: Understanding the differences in vascular microcirculation of the peripapillary retinal nerve fiber layer (RNFL) between the hemispheres in eyes with glaucoma with single-hemifield visual field (VF) defects may provide insight into the pathophysiology of glaucoma. Objective: To investigate the changes in the microcirculation of the peripapillary RNFL of eyes with glaucoma by using optical microangiography. Design, Setting, and Participants: Eyes with glaucoma and single-hemifield VF defect and normal eyes underwent scanning using an optical microangiography system covering a 6.7 × 6.7-mm2 area centered at the optic nerve head. The RNFL microcirculation was measured within an annulus region centered at the optic nerve head divided into superior and inferior hemispheres. Blood flux index (the mean flow signal intensity in the vessels) and vessel area density (the percentage of the detected vessels in the annulus) were measured. Main Outcomes and Measures: Differences in microcirculation between the hemispheres in eyes with glaucoma and normal eyes and correlations among blood flow metrics, VF thresholds, and clinical optical coherence tomography structural measurements were assessed. Results: Twenty-one eyes from 21 patients with glaucoma (7 men and 14 women; mean [SD] age, 63.7 [9.9] years) and 20 eyes from 20 healthy control individuals (9 men and 11 women; mean [SD] age, 68.3 [10.7] years) were studied. In eyes with glaucoma, the abnormal hemisphere showed a thinner RNFL (mean [SE] difference, 23.5 [4.5] µm; 95% CI, 15.1-32.0 µm; P < .001), lower RNFL blood flux index (mean [SE] difference, 0.04 [0.01]; 95% CI, 0.02-0.05; P < .001), and less vessel area density (mean [SE] difference, 0.08% [0.02%]; 95% CI, 0.05%-0.10%; P < .001) than did the normal hemisphere. Compared with normal eyes, reduced RNFL microcirculation was found in the normal hemisphere of eyes with glaucoma, measured by mean [SE] differences in blood flux index (0.06 [0.01]; 95% CI, 0.04-0.09; P < .001) and vessel area density (0.04% [0.02%]; 95% CI, 0.02%-0.08%; P = .003) but not in RNFL thickness (3.4 [4.7] µm; 95% CI, -6.2 to 12.9 µm; P = .48). Strong correlations were found between the blood flux index and VF mean deviation (Spearman ρ = 0.44; P = .045) and RNFL thickness (Spearman ρ = 0.65; P = .001) in the normal hemisphere of the eye with glaucoma. Conclusions and Relevance: Reduced RNFL microcirculation was detected in the normal hemisphere of eyes with glaucoma, with strong correspondence with VF loss and RNFL thinning. Although the results suggest that vascular dysfunction precedes structural changes seen in glaucoma, longitudinal studies would be needed to confirm this finding.
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Glaucoma/fisiopatologia , Microcirculação/fisiologia , Disco Óptico/irrigação sanguínea , Células Ganglionares da Retina/patologia , Vasos Retinianos/fisiopatologia , Escotoma/fisiopatologia , Campos Visuais , Idoso , Feminino , Glaucoma/complicações , Glaucoma/diagnóstico , Humanos , Pressão Intraocular , Masculino , Pessoa de Meia-Idade , Fibras Nervosas/patologia , Vasos Retinianos/diagnóstico por imagem , Escotoma/diagnóstico , Escotoma/etiologia , Tomografia de Coerência Óptica/métodosRESUMO
The present work attempts to develop and statistically optimize transfersomes containing EGCG and hyaluronic acid to synergize the UV radiation-protective ability of both compounds, along with imparting antioxidant and anti-aging effects. Transfersomes were prepared by thin film hydration technique, using soy phosphatidylcholine and sodium cholate, combined with high-pressure homogenization. They were characterized with respect to size, polydispersity index, zeta potential, morphology, entrapment efficiency, Fourier Transform Infrared Spectroscopy (FTIR), Differential Scanning Calorimetry (DSC), X-ray Diffraction (XRD), in vitro antioxidant activity and ex vivo skin permeation studies. Cell viability, lipid peroxidation, intracellular ROS levels and expression of MMPs (2 and 9) were determined in human keratinocyte cell lines (HaCaT). The composition of the transfersomes was statistically optimized by Design of Experiments using Box-Behnken design with four factors at three levels. The optimized transfersome formulation showed vesicle size, polydispersity index and zeta potential of 101.2 ± 6.0 nm, 0.245 ± 0.069 and -44.8 ± 5.24 mV, respectively. FTIR and DSC showed no interaction between EGCG and the selected excipients. XRD results revealed no form conversion of EGCG in its transfersomal form. The optimized transfersomes were found to increase the cell viability and reduce the lipid peroxidation, intracellular ROS and expression of MMPs in HaCaT cells. The optimized transfersomal formulation of EGCG and HA exhibited considerably higher skin permeation and deposition of EGCG than that observed with plain EGCG. The results underline the potential application of the developed transfersomes in sunscreen cream/lotions for improvement of UV radiation-protection along with deriving antioxidant and anti-aging effects.
Assuntos
Antioxidantes/administração & dosagem , Catequina/análogos & derivados , Portadores de Fármacos , Ácido Hialurônico/administração & dosagem , Queratinócitos/efeitos dos fármacos , Nanopartículas , Fosfatidilcolinas/química , Envelhecimento da Pele/efeitos dos fármacos , Pele/efeitos dos fármacos , Colato de Sódio/química , Administração Cutânea , Animais , Antioxidantes/química , Antioxidantes/metabolismo , Varredura Diferencial de Calorimetria , Catequina/administração & dosagem , Catequina/química , Catequina/metabolismo , Linhagem Celular , Sobrevivência Celular/efeitos dos fármacos , Sobrevivência Celular/efeitos da radiação , Composição de Medicamentos , Sinergismo Farmacológico , Humanos , Ácido Hialurônico/química , Ácido Hialurônico/metabolismo , Queratinócitos/metabolismo , Queratinócitos/patologia , Queratinócitos/efeitos da radiação , Peroxidação de Lipídeos/efeitos dos fármacos , Peroxidação de Lipídeos/efeitos da radiação , Masculino , Metaloproteinases da Matriz/metabolismo , Nanomedicina , Estresse Oxidativo/efeitos dos fármacos , Estresse Oxidativo/efeitos da radiação , Tamanho da Partícula , Permeabilidade , Ratos Wistar , Espécies Reativas de Oxigênio/metabolismo , Pele/metabolismo , Pele/patologia , Pele/efeitos da radiação , Absorção Cutânea , Envelhecimento da Pele/efeitos da radiação , Espectroscopia de Infravermelho com Transformada de Fourier , Propriedades de Superfície , Tecnologia Farmacêutica/métodos , Fatores de Tempo , Difração de Raios XRESUMO
PURPOSE: To investigate optic disc perfusion differences in normal, primary open-angle glaucoma (POAG), and normal tension glaucoma (NTG) eyes using optical microangiography (OMAG) based optical coherence tomography (OCT) angiography technique. DESIGN: Cross-sectional, observational study. SUBJECTS: Twenty-eight normal, 30 POAG, and 31 NTG subjects. METHODS: One eye from each subject was scanned with a 68 kHz Cirrus HD-OCT 5,000-based OMAG prototype system centered at the optic nerve head (ONH) (Carl Zeiss Meditec Inc, Dublin, CA). Microvascular images were generated from the OMAG dataset by detecting the differences in OCT signal between consecutive B-scans. The pre-laminar layer (preLC) was isolated by a semi-automatic segmentation program. MAIN OUTCOME MEASURES: Optic disc perfusion, quantified as flux, vessel area density, and normalized flux (flux normalized by the vessel area) within the ONH. RESULTS: Glaucomatous eyes had significantly lower optic disc perfusion in preLC in all three perfusion metrics (p<0.0001) compared to normal eyes. The visual field (VF) mean deviation (MD) and pattern standard deviation (PSD) were similar between the POAG and NTG groups, and no differences in optic disc perfusion were observed between POAG and NTG. Univariate analysis revealed significant correlation between optic disc perfusion and VF MD, VF PSD, and rim area in both POAG and NTG groups (p≤0.0288). However, normalized optic disc perfusion was correlated with some structural measures (retinal nerve fiber layer thickness and ONH cup/disc ratio) only in POAG eyes. CONCLUSIONS: Optic disc perfusion detected with OMAG was significantly reduced in POAG and NTG groups compared to normal controls, but no difference was seen between POAG and NTG groups with similar levels of VF damage. Disc perfusion was significantly correlated with VF MD, VF PSD, and rim area in glaucomatous eyes. Vascular changes at the optic disc as measured using OMAG may provide useful information for diagnosis and monitoring of glaucoma.
Assuntos
Angiografia/métodos , Glaucoma de Ângulo Aberto/fisiopatologia , Glaucoma de Baixa Tensão/fisiopatologia , Disco Óptico/irrigação sanguínea , Tomografia de Coerência Óptica/métodos , Estudos de Casos e Controles , Glaucoma de Ângulo Aberto/diagnóstico por imagem , Humanos , Glaucoma de Baixa Tensão/diagnóstico por imagemRESUMO
Optical coherence tomography angiography (OCTA) has increasingly become a clinically useful technique in ophthalmic imaging. We evaluate the repeatability and reproducibility of blood perfusion in the optic nerve head (ONH) measured using optical microangiography (OMAG)-based OCTA. Ten eyes from 10 healthy volunteers are recruited and scanned three times with a 68-kHz Cirrus HD-OCT 5000-based OMAG prototype system (Carl Zeiss Meditec Inc., Dublin, California) centered at the ONH involving two separate visits within six weeks. Vascular images are generated with OMAG processing by detecting the differences in OCT signals between consecutive B-scans acquired at the same retina location. ONH perfusion is quantified as flux, vessel area density, and normalized flux within the ONH for the prelaminar, lamina cribrosa, and the full ONH. Coefficient of variation (CV) and intraclass correlation coefficient (ICC) are used to evaluate intravisit and intervisit repeatability, and interobserver reproducibility. ONH perfusion measurements show high repeatability [CV≤3.7% (intravisit) and ≤5.2% (intervisit)] and interobserver reproducibility (ICC≤0.966) in all three layers by three metrics. OCTA provides a noninvasive method to visualize and quantify ONH perfusion in human eyes with excellent repeatability and reproducibility, which may add additional insight into ONH perfusion in clinical practice.
Assuntos
Angiografia/instrumentação , Angiografia/métodos , Disco Óptico/irrigação sanguínea , Disco Óptico/diagnóstico por imagem , Tomografia de Coerência Óptica , Humanos , Reprodutibilidade dos Testes , Tomografia de Coerência Óptica/normasRESUMO
PURPOSE: To investigate the vascular microcirculation changes in the retinal nerve fiber layer (RNFL) in normal, glaucoma suspect, and open-angle glaucoma (OAG) groups using optical coherence tomography-based microangiography (OMAG). METHODS: One eye from each subject was scanned with a Cirrus HD-OCT 5000-based OMAG prototype system montage scanning protocol centered at the optic nerve head (ONH). Blood flow signals were extracted using OMAG algorithm. Retinal nerve fiber layer vascular microcirculation was measured by calculating the blood flux index and vessel area density within a 1.2-mm width annulus centered at the ONH with exclusion of big retinal vessels. One-way ANOVA were performed to analyze the RNFL microcirculation among groups. Linear-regression models were constructed to analyze the correlation between RNFL microcirculation and clinical parameters. Discrimination capabilities of the flow metrics were assessed with the area under the receiver operating characteristic curve (AROC). RESULTS: Twenty normal, 26 glaucoma suspect, and 42 OAG subjects were enrolled. Eyes from OAG subjects and glaucoma suspects showed significantly lower blood flux index compared with normal eyes (P ≤ 0.0015). Retinal nerve fiber layer blood flow metrics showed significant correlations with visual field indices and structural changes in glaucomatous eyes (P ≤ 0.0123). Similar discrimination capability of blood flux index compared with RNFL thickness was found in both disease groups. CONCLUSIONS: Peripapillary RNFL vascular microcirculation measured as blood flux index by OMAG showed significant differences among OAG, glaucoma suspect, and normal controls and was significantly correlated with functional and structural defects. Retinal nerve fiber layer microcirculation measurement using OMAG may help physicians monitor glaucoma.
Assuntos
Glaucoma/fisiopatologia , Microcirculação/fisiologia , Fibras Nervosas/patologia , Disco Óptico/irrigação sanguínea , Células Ganglionares da Retina/patologia , Vasos Retinianos/fisiopatologia , Tomografia de Coerência Óptica/métodos , Idoso , Feminino , Angiofluoresceinografia , Fundo de Olho , Glaucoma/diagnóstico , Humanos , Pressão Intraocular , Masculino , Pessoa de Meia-Idade , Disco Óptico/fisiopatologia , Curva ROC , Vasos Retinianos/patologia , Campos VisuaisRESUMO
BACKGROUND: To investigate the differences of perfusion in the optic nerve head (ONH) between normal and glaucomatous eyes using optical microangiography (OMAG) based optical coherence tomography (OCT) angiography technique. METHODS: One eye from each subject was scanned with a 68 kHz Cirrus 5000 HD-OCT-based OMAG prototype system centered at the ONH (Carl Zeiss Meditec Inc, Dublin, CA, USA). Microvascular images were generated from the OMAG dataset by detecting the differences in OCT signal between consecutive B-scans. The pre-laminar layer (preLC) was isolated by a semi-automatic segmentation program. En face OMAG images for preLC were generated using signals with highest blood flow signal intensity. ONH perfusion was quantified as flux, vessel area density, and normalized flux within the ONH. Standard t-tests were performed to analyze the ONH perfusion differences between normal and glaucomatous eyes. Linear regression models were constructed to analyze the correlation between ONH perfusion and other clinical measurements. RESULTS: Twenty normal and 21 glaucoma subjects were enrolled. Glaucomatous eyes had significantly lower ONH perfusion in preLC in all three perfusion metrics compared to normal eyes (P≤0.0003). Significant correlations between ONH perfusion and disease severity as well as structural changes were detected in glaucomatous eyes (P≤0.012). CONCLUSIONS: ONH perfusion detected by OMAG showed significant differences between glaucoma and normal controls and was significantly correlated with disease severity and structural defects in glaucomatous eyes. ONH perfusion measurement using OMAG may provide useful information for detection and monitoring of glaucoma.