RESUMO
INTRODUCTION: Eye injuries can cause decreased vision or even blindness, and predispose to future complications. Wood as an independent cause of eye injuries has infrequently been the focus of the studies. The aim of this study is to report the current population-based epidemiology, treatment, use of resources and outcomes of eye injuries caused by sticks, branches, and other wooden projectiles in Finland. METHODS: The study included all patients injured by wooden projectiles with ocular or orbital traumas over a 1-y period. Patients were treated at the Helsinki University eye hospital, which covers a population of 1.5 million. The follow-up time was 3 mo. RESULTS: Wooden projectiles caused 67 eye injuries and compromised 6% of all eye traumas during 1 y. Of the patients, males predominated (76%) and 22% were children under 17 y. Injury was most likely in spring (36%) and in males aged 51 to 67 y. The most common activity to cause injury was playing (27%), but in relation to time spent in each activity, the highest risk for eye injury was in gardening. Diagnoses were mild superficial trauma (54%), blunt ocular trauma (37%), eyelid wound (4%), orbital fracture (3%), and open globe trauma (1%). Permanent disability was estimated for 10% and a need for lifelong follow-up was estimated for 37%. Eleven patients needed major surgeries. CONCLUSIONS: Wooden projectiles often cause serious eye injuries, permanent disability, and a need for lifelong follow-up. Caution is required to protect the eyes when playing with sticks and during gardening, forest work, and woodwork.
Assuntos
Traumatismos Oculares , Traumatismo Múltiplo , Ferimentos não Penetrantes , Criança , Traumatismos Oculares/epidemiologia , Traumatismos Oculares/etiologia , Traumatismos Oculares/terapia , Finlândia/epidemiologia , Humanos , Masculino , Estudos Retrospectivos , Acuidade VisualRESUMO
PURPOSE: To quantify and characterize the epidemiology, treatments, long-term outcome, and use of resources for work tool-related eye injuries and their severity. METHODS: We included all new patients with a work tool-related eye injury treated at the Helsinki University Eye Hospital in 1 year. The data were from hospital records, examinations, and patient questionnaires. The follow-ups were at 3 months and 6 years. RESULTS: Work tools caused 3% (37/1151) of all eye injuries. The mean age was 37 and 84% were men. Most injuries (84%) occurred at work (17) or at home (15). There were 14 minor injuries, 12 contusions, 9 open globe injuries (OGI), and 2 eyelid wounds. The annual incidence of work tool-related eye injuries was 2.4/100,000 and hospitalization 0.6/100,000. At 6-year follow-up, we re-examined 18 patients and 17 were interviewed by phone. Four patients were blinded. We recorded 690 sick leave days and 43 major operations. No traumatic glaucoma was diagnosed. Fifteen patients needed lifelong follow-up. Permanent impairment occurred in 30% (11) of work tool-related eye injuries, from whom, nine were caused by manual tools. Work tools comprised 10% of the permanently impaired, but 2.5% of the non-permanently impaired cases among all eye injuries (1151). CONCLUSION: The proportional difference between the permanently impaired and the non-permanently impaired was higher in work tool-related eye injuries than other causes reported in previous Helsinki Ocular Trauma Studies. High-risk injuries were mainly caused by manual tools and nails and resulted in OGI.
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Traumatismos Oculares/epidemiologia , Hospitalização/estatística & dados numéricos , Hospitais Universitários/estatística & dados numéricos , População Urbana/estatística & dados numéricos , Acuidade Visual , Adolescente , Adulto , Distribuição por Idade , Idoso , Criança , Pré-Escolar , Traumatismos Oculares/etiologia , Feminino , Finlândia/epidemiologia , Seguimentos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Distribuição por Sexo , Fatores de Tempo , Adulto JovemRESUMO
PURPOSE: To estimate incidence of and analyze risk factors for developing secondary glaucoma in eyes with uveal melanoma before and after diagnosis. DESIGN: A cross-sectional, population-based cohort study. PARTICIPANTS: Seven hundred eighty-one patients (median age, 64 years; range, 14-93) consecutively diagnosed with uveal melanoma from 1997 to 2012 in a national ocular oncology service, 708 (91%) of whom received ruthenium (50%) or iodine (50%) brachytherapy. METHODS: Patient, tumor, treatment, and follow-up data were collected prospectively. Frequency and associations of melanoma-related glaucoma at tumor diagnosis were assessed. Incidence of developing secondary glaucoma after diagnosis was estimated by Kaplan-Meier analysis. Independent risk factors were modeled using Cox regression. MAIN OUTCOME MEASURES: Melanoma-related glaucoma and related risk factors. RESULTS: Forty-five patients (5.8%; 95% confidence interval [CI], 4.2-7.6) had tumor-related secondary glaucoma at diagnosis, 34 (76%) from a narrow-to-closed angle (25 had direct angle invasion) and 10 (22%) from anterior neovascularization. Synchronous metastases were common in patients with initial secondary glaucoma (11% vs. 1.2% with incident glaucoma, P = 0.005). Patients with secondary glaucoma were often male (58% vs. 48% without glaucoma; P = 0.010) and had larger tumors (median thickness, 9.1 vs. 4.0 mm; P < 0.001) involving the ciliary body (43% vs. 21%; P < 0.001) with retinal detachment (53% vs. 30%; P < 0.001). One hundred and sixty-eight patients 165 of which were treated with brachytherapy developed incident tumor- or treatment-related secondary glaucoma a median of 1.7 years (range, 0.1-13.6) after tumor diagnosis. Cumulative proportion of developing secondary glaucoma was 23% (95% CI, 20-27) at 5 years. The most common mechanism was neovascularization in 119 patients (71%; 95% CI, 63-78). By multivariable regression, initial retinal detachment 3 to 4 quadrants (hazard ratio [HR], 2.18; P < 0.001), initial intraocular pressure 17 mmHg or higher (HR, 1.64; P = 0.01), and tumor thickness predicted incident secondary glaucoma. CONCLUSIONS: Secondary glaucoma at initial uveal melanoma diagnosis predicts high risk of synchronous metastases. Although anterior neovascularization is the most common mechanism for secondary glaucoma after diagnosis, other mechanisms such as angle narrowing and anterior chamber hemorrhage are not infrequent. Initial retinal detachment and intraocular pressure with tumor thickness could inform interim assessments of intraocular pressure and neovascularization.
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Glaucoma , Melanoma , Descolamento Retiniano , Neoplasias Uveais , Humanos , Masculino , Pessoa de Meia-Idade , Incidência , Estudos de Coortes , Estudos Transversais , Glaucoma/diagnóstico , Glaucoma/epidemiologia , Glaucoma/etiologia , Neoplasias Uveais/complicações , Neoplasias Uveais/diagnóstico , Neoplasias Uveais/epidemiologia , Melanoma/complicações , Melanoma/diagnóstico , Melanoma/epidemiologia , Fatores de RiscoRESUMO
Loss of vision and visual impairment due to glaucoma can be prevented or delayed, if the disease is detected at an early stage. The most important risk factors for open-angle glaucoma include age, elevated intraocular pressure, exfoliation of the lens, i.e. exfoliation syndrome, and genetic factors. To date, genetic studies on glaucoma have revealed more than 20 gene loci and three candidate genes, myocilin (MYOC), optineurin (OPTN) and WD repeat domain 36 (WDR36). A mutation in both the MYOC and WDR36 genes has been found in Finnish families.
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Genoma Humano , Glaucoma de Ângulo Aberto/genética , Proteínas de Ciclo Celular , Proteínas do Citoesqueleto/genética , Proteínas do Olho/genética , Finlândia/epidemiologia , Glaucoma de Ângulo Aberto/epidemiologia , Glicoproteínas/genética , Humanos , Proteínas de Membrana Transportadoras , Mutação , Fator de Transcrição TFIIIA/genéticaRESUMO
BACKGROUND: Glaucoma treatments are mostly presented in uni-dose or multi-dose format. A certain number of patients with visual acuity and dexterity problems may have problems in instilling eye drops. AIM: To assess patient satisfaction and ease of use of a preservative-free glaucoma treatment (dorzolamide/timolol) in a new and innovative patented multi-dose delivery system. METHODS: Retrospective, international, multicentre, non-interventional study in 788 adult patients using a multi-dose delivery system for at least 28 days. RESULTS: Mean patient age was 68.1 ± 12.1 years. Mean duration of multi-dose delivery system use was 132.1 ± 125.1 days; 66.5% of the patients previously used multi-dose and 33.5% uni-dose delivery systems (n = 734); 78.3% of the patients were satisfied or very satisfied with the multi-dose delivery system. A significant majority (all p ≤ 0.045) of patients with a QuickDash® score between [0 to 25[ (66.4%, n = 211) and [50 to 75[ (81.8%, n = 11) rated multi-dose delivery system as easy or very easy to open and significantly more subjects in the [0 to 25[ (72%) score group rated multi-dose delivery system as being better or much better than their previous device (n = 211). Significantly (all p < 0.01) more subjects with available visual acuity results rated multi-dose delivery system as good, better or much better than their previous dispensing device. CONCLUSION: The tested multi-dose delivery system was highly accepted. It is, therefore, suitable for glaucoma patients with decreased visual acuity and/or dexterity problems. Further studies may be necessary to assess the easiness of use of this easy-to-grip delivery system.
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Glaucoma de Ângulo Aberto , Glaucoma , Hipertensão Ocular , Adulto , Anti-Hipertensivos/uso terapêutico , Criança , Glaucoma/tratamento farmacológico , Glaucoma de Ângulo Aberto/tratamento farmacológico , Humanos , Pressão Intraocular , Hipertensão Ocular/tratamento farmacológico , Soluções Oftálmicas , Estudos Retrospectivos , Timolol , Resultado do TratamentoRESUMO
In this study, three single-nucleotide polymorphisms (SNPs) on the lysyl oxidase-like 1 (LOXL1) gene associated with exfoliation syndrome (XFS) and exfoliation glaucoma (XFG) were investigated in the Finnish population. A case-control study of 59 sporadic patients with XFS, 82 with XFG, 71 with primary open-angle glaucoma (POAG) and 26 individuals without these disorders from the southern Finnish population, and a family study of an extended family with 28 patients with XFS or XFG and 92 unaffected relatives from Kökar islands, Southwestern Finnish archipelago, were conducted. Anonymous blood donors (n=404) were studied as population-based controls. Three SNPs, rs1048661 (R141L), rs3825942 (G153D) and rs2165241, of the LOXL1 gene were genotyped by PCR sequencing. Association and linkage analyses were carried out. In both case-control and family materials, significant association for allele G of rs1048661 (P=2.65 x 10(-5); P=0.0007), allele G of rs3825942 (P=2.24 x 10(-8); P=0.49) and allele T of rs2165241 (P=2.62 x 10(-13); P<0.0001) was found in XFS/XFG. However, linkage was not observed for LOXL1 risk alleles. The corresponding three-locus haplotype GGT increased the risk of XFS/ XFG nearly 15-fold relative to low-risk haplotype GAC (odds ratio (OR): 14.9, P=1.6 x 10(-16)). In conclusion, the earlier reported polymorphisms of the LOXL1 gene showed significant association also in the Finnish population.
Assuntos
Aminoácido Oxirredutases/genética , Síndrome de Exfoliação/genética , Predisposição Genética para Doença , Idoso de 80 Anos ou mais , Alelos , Estudos de Casos e Controles , Síndrome de Exfoliação/complicações , Família , Finlândia/etnologia , Ligação Genética , Loci Gênicos/genética , Glaucoma de Ângulo Aberto/complicações , Glaucoma de Ângulo Aberto/genética , Haplótipos/genética , Humanos , Polimorfismo de Nucleotídeo Único/genéticaRESUMO
BACKGROUND: Optic nerve head damage may result from high intraocular pressure (IOP) associated with the exfoliation syndrome (EXS). At equal IOP levels, eyes with EXS may suffer damage more easily than eyes without EXS. Opinion differs as to whether EXS alone, without the contributory effect of a raised IOP, is a risk factor for optic nerve head damage. METHODS: 36 nonglaucomatous, normotensive patients (mean age 68.4 +/- 7.1 years) with unilateral EXS were examined for optic disc topography with confocal scanning laser ophthalmoscopy (the Heidelberg Retina Tomograph). The only patients included were those with an IOP difference of < or =3 mmHg between fellow eyes and with IOP fluctuation < or =5 mmHg in diurnal curves. RESULTS: Mean IOP was higher in the EXS than in the fellow non-EXS eyes (15.0 +/- 2.8 vs 14.1 +/- 2.7 mmHg, P < 0.001). According to the multivariate analysis of variance, no differences existed in the global parameters between EXS and non-EXS eyes (P = 0.778). Nor did differences appear in sectoral parameters between fellow eyes in the temporal (P = 0.634), temporal superior (P = 0.236), temporal inferior (P = 0.330), nasal (P = 0.711), nasal superior (P = 0.307), and nasal inferior (P = 0.434) sectors. CONCLUSION: EXS may not in itself be a risk factor for optic disc damage when IOP is not elevated from its base level, and when its variation is normal.
Assuntos
Síndrome de Exfoliação/diagnóstico , Glaucoma de Ângulo Aberto/diagnóstico , Disco Óptico/patologia , Doenças do Nervo Óptico/diagnóstico , Idoso , Feminino , Humanos , Pressão Intraocular , Masculino , Pessoa de Meia-Idade , Oftalmoscopia , Fatores de Risco , Tonometria OcularRESUMO
Drug therapy for glaucoma is based on lowering of intraocular pressure regardless of the pressure level, at which the disease has been diagnosed. Earlier it was empirically clear that in disease cases involving a high pressure, drug therapy will slow down the advancement of the disease. During the last ten years scientific evidence has accumulated indicating that a disease with normal pressure is also worth treating. Drug therapy can also postpone the onset of glaucoma at a time when intraocular pressure is high, yet without structural or functional damage.
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Glaucoma/tratamento farmacológico , Antagonistas Adrenérgicos beta/uso terapêutico , Anti-Hipertensivos/uso terapêutico , Progressão da Doença , Glaucoma/fisiopatologia , Glaucoma/prevenção & controle , Humanos , Pressão Intraocular/efeitos dos fármacos , Antagonistas Muscarínicos/uso terapêutico , Pilocarpina/uso terapêutico , Timolol/uso terapêuticoRESUMO
PURPOSE: We report the epidemiology, findings, treatment, long-term outcome and use of resources for eye injuries caused by toy guns in southern Finland. METHODS: All new patients injured by toy guns in one year (2011-2012) and treated at Helsinki University Eye Hospital were included. Follow-ups occurred at 3 months and 5 years. RESULTS: Toy guns caused 15 eye traumas (1% of all eye traumas). Most patients were male (n = 14) and children aged under 16 years (n = 13). Toy guns involved were airsoft guns (n = 12), pea shooters (n = 2) and paintball (n = 1). Eleven patients did not use protective eyewear, and four patients discontinued their use during the game. Seven patients were not active participants in the game. Blunt ocular trauma was the primary diagnosis in 13 patients and corneal abrasion in two. Seven patients had retinal findings. In the 5-year follow-up, eight of 15 patients had abnormal ocular findings: three had artificial intraocular lens, two iridodialysis, and one each retinal plomb, mydriasis or iris tear. None had glaucoma. Seven patients had permanent subjective impairment due to pain, lowered visual acuity, blur or difficulty in focusing. Four patients needed seven operations. The number of outpatient visits was 90. One patient required hospitalization. CONCLUSION: Toy guns cause serious eye traumas. No glaucoma was found. Proper use of toy guns and protective eyewear during the whole game should be emphasized to both players and bystanders. We recommend that in Finland the selling of airsoft guns be placed under the Firearms Act to make the hazards of airsoft guns known.
Assuntos
Traumatismos Oculares/epidemiologia , Dispositivos de Proteção dos Olhos , Armas de Fogo , Jogos e Brinquedos/lesões , Acuidade Visual , Ferimentos não Penetrantes/epidemiologia , Adolescente , Adulto , Criança , Pré-Escolar , Traumatismos Oculares/diagnóstico , Traumatismos Oculares/prevenção & controle , Feminino , Finlândia/epidemiologia , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Fatores de Tempo , Índices de Gravidade do Trauma , Ferimentos não Penetrantes/prevenção & controle , Adulto JovemRESUMO
A 19-year-old man noticed blurred vision in his right eye. He had an intraocular pressure of 60 versus 12 mmHg in the fellow eye. He was initially diagnosed with an atypical, advanced pigmentary glaucoma. The intraocular pressure did not respond to maximal medication, deep sclerectomy, goniopuncture, and 2 cyclophotocoagulations. Sixteen months after presentation, malignancy was first suspected, and the eye was enucleated. A ring melanoma of the anterior chamber angle was confirmed by the histopathologic examination. Normal nuclear staining for breast cancer 1 gene (BRCA1)-associated protein 1 suggested that the tumor was likely of disomy 3 type with a favorable prognosis. No local or systemic recurrence has developed within 4 years. A literature review of this rare type of minimal volume diffuse uveal melanoma identified 18 additional patients. The initial diagnosis in 18 of the 19 patients with a ring melanoma of the anterior chamber angle was unilateral glaucoma with a median intraocular pressure of 40 mmHg and an age range of 16-76 years. Liver metastasis developed in 5 of 12 patients older than 45 years. This rare subtype is estimated to account for 0.05%-0.16% of all uveal melanomas.
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Câmara Anterior/patologia , Enucleação Ocular/métodos , Glaucoma de Ângulo Aberto/diagnóstico , Melanoma/diagnóstico , Neoplasias Uveais/diagnóstico , Diagnóstico Diferencial , Gonioscopia , Humanos , Pressão Intraocular/fisiologia , Masculino , Melanoma/cirurgia , Microscopia Acústica , Neoplasias Uveais/cirurgia , Adulto JovemRESUMO
PURPOSE: To study the role of myocilin (MYOC) as a susceptibility gene for juvenile- and adult-onset open-angle glaucoma (JOAG and POAG, respectively). METHODS: In a six-generation Finnish family with JOAG and POAG, we performed thorough ophthalmologic characterization (including assessment of the visual fields by Octopus perimetry, nerve-fiber layer thickness by photography, and disc size by Heidelberg tomography) of 51 individuals. The coding region of MYOC was screened for mutations by PCR amplification and direct sequencing. RESULTS: We detected a C > T transition at codon 377 resulting in a substitution of a threonine residue for methionine (Thr377Met) in the olfactomedin-like domain of myocilin, segregating in the family. Of the 20 individuals heterozygous for the mutation, nine (45%) were glaucomatous and two (10%) had ocular hypertension (OHT). The mean age at diagnosis of glaucoma in these individuals was 34.3 years (range: 14-66 years). Moreover, three of these individuals suffered retinal vein occlusion (RVO) in one eye, while one individual without the mutation had RVO. CONCLUSION: Our results further support the evidence that the Thr377Met mutation in MYOC may represent a susceptibility allele for glaucoma. These findings may facilitate genetic counseling, and early diagnosis and treatment of glaucoma. The possible interaction of factors contributing to RVO in conjunction with the Thr377Met mutation warrants further investigation.
Assuntos
Proteínas do Olho/genética , Glaucoma de Ângulo Aberto/genética , Glicoproteínas/genética , Mutação Puntual/genética , Adolescente , Adulto , Idade de Início , Idoso , Criança , Proteínas do Citoesqueleto , Feminino , Finlândia , Glaucoma de Ângulo Aberto/patologia , Humanos , Pressão Intraocular , Masculino , Pessoa de Meia-Idade , Hipertensão Ocular/genética , Hipertensão Ocular/patologia , Disco Óptico/patologia , Linhagem , Penetrância , Reação em Cadeia da Polimerase , Campos VisuaisRESUMO
PURPOSE: This prospective 10-year follow-up study was conducted to examine conversion of nonglaucomatous eyes with unilateral exfoliation syndrome (EXS) to bilateral EXS and to glaucoma. Risk factors for conversion to a bilateral condition and to glaucoma were studied. PATIENTS: Sixty-three nonglaucomatous subjects (mean age, 68.6 +/- 6.2 years) with unilateral EXS were enrolled. Of these patients, 56 were followed-up (89%). The effects of age, initial intraocular pressure (IOP), IOP difference between the fellow eyes, angle pigmentation, amount of exfoliation material, pupillary dilatation, optic disc topography, and phenylephrine-induced pigmentary dispersion on occasional conversion to the bilateral form and to glaucoma were studied by multivariate survival analysis. RESULTS: In 10 years, 38% had converted to bilateral EXS. Conversion to exfoliation glaucoma (EG) was 32% in the initially exfoliative eyes and 38% in the initially nonexfoliative (non-EXS) fellow eyes. Primary open-angle glaucoma developed in 3.5% of the non-EXS eyes. In the initially EXS eyes, a significant association was found between the initial IOP and conversion to EG (relative risk = 1.471, = 0.0001). When initial IOP was removed from the model, the pupillary dilatation values (relative risk = 0.488, = 0.035) and the differences in IOP between the fellow eyes (relative risk = 1.224, = 0.0181) were associated with conversion to EG. None of the factors studied was associated with conversion to the bilateral form. CONCLUSION: In unilateral EXS, factors associated with conversion to EG were initial IOP, pupillary dilatation value, and difference in IOP between the fellow eyes. No risk factors for conversion to bilateral EXS were found.
Assuntos
Síndrome de Exfoliação/complicações , Glaucoma de Ângulo Aberto/etiologia , Idoso , Idoso de 80 Anos ou mais , Síndrome de Exfoliação/diagnóstico , Síndrome de Exfoliação/fisiopatologia , Feminino , Seguimentos , Glaucoma de Ângulo Aberto/diagnóstico , Glaucoma de Ângulo Aberto/fisiopatologia , Humanos , Pressão Intraocular , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de RiscoRESUMO
PURPOSE: To examine the effect of 670-nm diode laser cyclophotocoagulation on corneal morphology, density of corneal subbasal nerves, corneal mechanical sensitivity, and the rate of tear fluid secretion in human eyes. PATIENTS AND METHODS: Transscleral contact cyclophotocoagulation was performed in 10 eyes of 10 consecutive patients on 180 degrees of the pars plicata of the ciliary body, using a 670-nm diode laser (power = 430 mW, application time = 10 seconds). In vivo confocal microscopy, with special attention to corneal morphology and the density of the subbasal nerves in the central and inferior perilimbal cornea, was performed preoperatively, and at 3 days and 1 month postoperatively. Corneal mechanical sensitivity was tested preoperatively, and at 3 days and 1 month postoperatively, using a Cochet-Bonnet esthesiometer. The rate of tear fluid secretion was measured preoperatively and 1 month postoperatively, using the Schirmer basic secretion tear test with topical anesthesia. RESULTS: After cyclophotocoagulation, in vivo confocal microscopy did not reveal any changes in any of the corneal layers or in the corneal subbasal nerves. After treatment, as compared with baseline (paired samples test, > 0.05), there was no statistically significant change in the mechanical sensitivity values in any part of the cornea or in the Schirmer basic secretion tear test result. CONCLUSION: The results of this preliminary study suggest that cyclophotocoagulation with the 670-nm diode laser does not impair corneal innervation.
Assuntos
Corpo Ciliar/cirurgia , Córnea/inervação , Córnea/fisiologia , Glaucoma de Ângulo Aberto/cirurgia , Fotocoagulação a Laser , Sensação/fisiologia , Lágrimas/metabolismo , Idoso , Idoso de 80 Anos ou mais , Síndrome de Exfoliação/cirurgia , Feminino , Humanos , Pressão Intraocular , Masculino , Microscopia Confocal , Nervo Oftálmico/citologia , Nervo Oftálmico/fisiologiaRESUMO
PURPOSE: To evaluate retrospectively the usefulness of the red diode and krypton laser for transscleral contact cyclophotocoagulation (CPC) in the treatment of secondary glaucoma in eyes with uveal melanoma. PATIENTS AND METHODS: Twenty-seven eyes of 27 patients (mean age, 66 y; range, 33 to 85 y) with a uveal melanoma and secondary glaucoma were treated with a transscleral 670-nm diode (40 treatments) and 647-nm krypton (5 treatments) laser CPC; 25 eyes had been or were subsequently treated with brachytherapy. The energy used was 420 mW at the tip of the probe (exposure time, 10 s). Seventeen eyes were treated once, 6 eyes twice, and 4 eyes 3 to 6 times. The aim was to preserve vision in 21 patients and to relieve pain in 6 patients. Fourteen patients (52%) died during follow-up. RESULTS: With ≥1 CPCs, the intraocular pressure decreased from a median of 40 mm Hg at baseline to 28 mm Hg at 12 months (n=18) and 23 mm Hg at 24 months (n=10). Hypotony developed in 6 eyes. Before CPC, 12 eyes had a best corrected visual acuity (BCVA) of 20/400 or better. At 12 months, 5 of 18 eyes had BCVA 20/400 or better, and at 24 months 4 of 10 eyes. Four eyes were removed. At the latest visit, 15 of 23 eyes had no light perception, but were preserved. All patients whose aim of treatment was to relieve pain achieved pain relief. CONCLUSIONS: CPC lowered intraocular pressure and the number of medications needed for secondary glaucoma in eyes with uveal melanoma, also providing pain relief.
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Corpo Ciliar/cirurgia , Glaucoma/cirurgia , Fotocoagulação a Laser/métodos , Lasers de Excimer/uso terapêutico , Lasers Semicondutores/uso terapêutico , Melanoma/complicações , Neoplasias Uveais/complicações , Adulto , Idoso , Idoso de 80 Anos ou mais , Braquiterapia , Feminino , Glaucoma/etiologia , Humanos , Pressão Intraocular/fisiologia , Masculino , Melanoma/patologia , Melanoma/radioterapia , Pessoa de Meia-Idade , Estudos Retrospectivos , Tonometria Ocular , Resultado do Tratamento , Neoplasias Uveais/patologia , Neoplasias Uveais/radioterapia , Acuidade Visual/fisiologiaRESUMO
PURPOSE: The purpose of this study was to investigate the tolerability and intraocular pressure (IOP) reducing effect of the first preservative-free prostaglandin tafluprost (Taflotan) in patients exhibiting ocular surface side-effects during latanoprost (Xalatan) treatment. METHODS: A total of 158 patients were enrolled in this open-label multicentre study. Eligible patients had to have at least two ocular symptoms, or one sign and one symptom, during treatment with latanoprost. At baseline, the patients were directly switched from latanoprost to preservative-free tafluprost for 12 weeks. The patients were queried for ocular symptoms, and ocular signs were assessed by using tear break-up time, Schirmer's test, fluorescein staining and evaluation of conjunctival hyperaemia and blepharitis. In addition, HLA-DR and MUC5AC in conjunctival impression cytology specimens were analyzed, and a drop discomfort/quality of life (QoL) questionnaire was employed. IOP was measured at all visits. RESULTS: Preservative-free tafluprost maintained IOP at the same level after 12- weeks treatment (16.4 +/- 2.7 mmHg) as latanoprost at baseline (16.8 +/- 2.5 mmHg). During treatment with preservative-free tafluprost, the number of patients having irritation/burning/stinging (56.3%), itching (46.8%), foreign body sensation (49.4%), tearing (55.1%) and dry eye sensation (64.6%) decreased to 28.4%, 26.5%, 27.1%, 27.1% and 39.4% correspondingly. The number of the patients with abnormal fluorescein staining of cornea (81.6%) and conjunctiva (84.2%), blepharitis (60.1%), conjunctival hyperaemia (84.2%) and abnormal Schirmer's test (71.5%) was also reduced significantly to 40.6%, 43.2%, 40.6%, 60.0% and 59.4% correspondingly. The tear break-up time improved significantly from 4.5 +/- 2.5 seconds to 7.8 +/- 4.9 seconds. A reduction in the number of patients with abnormal conjunctival cells based on HLA-DR and MUC5AC was also detected. CONCLUSIONS: Preservative-free tafluprost maintained IOP at the same level as latanoprost, but was better tolerated in patients having signs or symptoms while on preserved latanoprost. Preservative-free tafluprost treatment resulted in improved QoL, increased patient satisfaction and drop comfort.
Assuntos
Anti-Hipertensivos/administração & dosagem , Compostos de Benzalcônio/administração & dosagem , Síndrome de Exfoliação/tratamento farmacológico , Glaucoma de Ângulo Aberto/tratamento farmacológico , Pressão Intraocular/efeitos dos fármacos , Conservantes Farmacêuticos/administração & dosagem , Prostaglandinas F/administração & dosagem , Administração Tópica , Adulto , Idoso , Idoso de 80 Anos ou mais , Compostos de Benzalcônio/efeitos adversos , Blefarite/induzido quimicamente , Blefarite/metabolismo , Blefarite/prevenção & controle , Doenças da Túnica Conjuntiva/induzido quimicamente , Doenças da Túnica Conjuntiva/metabolismo , Doenças da Túnica Conjuntiva/prevenção & controle , Feminino , Gonioscopia , Antígenos HLA-DR/metabolismo , Humanos , Hiperemia/induzido quimicamente , Hiperemia/metabolismo , Hiperemia/prevenção & controle , Latanoprosta , Masculino , Pessoa de Meia-Idade , Mucina-5AC/metabolismo , Hipertensão Ocular/tratamento farmacológico , Oftalmoscopia , Satisfação do Paciente , Conservantes Farmacêuticos/efeitos adversos , Prostaglandinas F Sintéticas/administração & dosagem , Prostaglandinas F Sintéticas/efeitos adversos , Qualidade de Vida , Inquéritos e Questionários , Tonometria OcularRESUMO
PURPOSE: To retrospectively evaluate the results of cyclophotocoagulation (CPC) with the transscleral contact red 670-nm diode laser in treating glaucoma. METHODS: Cyclophotocoagulation was performed in 60 eyes of 60 patients with a mean age of 74 +/- 11 years (range 49-90 years). The treatment was delivered via a fibre-optic probe. The power per application was 430 mW. Exposure time was 10 seconds. RESULTS: The mean overall follow-up time after the initial CPC was 26 +/- 20 months (range 3-75 months). Preoperative intraocular pressure (IOP) was 27 +/- 11 mmHg (n = 60). After one or more CPC treatments, mean IOP decreased to 20 +/- 7 mmHg (n = 51) at 1 month, 19 +/- 5 mmHg (n = 45) at 3 months, 18 +/- 5 mmHg (n = 29) at 6 months, 19 +/- 7 mmHg (n = 22) at 1 year, 18 +/- 7 mmHg (n = 16) at 2 years, 14 +/- 4 mmHg (n = 8) at 3 years, and 18 +/- 6 mmHg (n = 60) at the last follow-up. An IOP of 8-21 mmHg or a > 30% decrease in IOP was obtained in 33 of 41 eyes (80%) with baseline IOP > 21 mmHg at the last follow-up. Hypotonia (IOP < 8 mmHg) did not develop in any of the eyes studied. CONCLUSIONS: Cyclophotocoagulation with the red 670-nm diode laser is an effective and well tolerated means of treating glaucoma.
Assuntos
Corpo Ciliar/cirurgia , Síndrome de Exfoliação/cirurgia , Glaucoma Neovascular/cirurgia , Glaucoma de Ângulo Aberto/cirurgia , Fotocoagulação a Laser , Lasers Semicondutores/uso terapêutico , Idoso , Idoso de 80 Anos ou mais , Síndrome de Exfoliação/fisiopatologia , Feminino , Seguimentos , Glaucoma Neovascular/fisiopatologia , Glaucoma de Ângulo Aberto/fisiopatologia , Humanos , Pressão Intraocular/fisiologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Esclera , Tonometria Ocular , Resultado do TratamentoRESUMO
PURPOSE: To evaluate transscleral contact red-laser cyclophotocoagulation (CPC), using a visible red 647-nm krypton or 670-nm diode laser and limited transscleral anterior retinal cryocoagulation in neovascular glaucoma. METHODS: In a retrospective case series, 35 eyes of 35 consecutive patients treated during a period of 6 years were included in the study. Inclusion was dependent on follow-up of at least 1 month. Patients who had undergone previous cyclodestructive procedures and patients who received an additional glaucoma operation in conjunction with CPC were excluded. In the combined procedure, the power per CPC application was 370-450 mW and exposure time was 10 seconds. One to two rows of cryoapplications were given to 360 degrees of the anterior retina. RESULTS: The success rate in terms of intraocular pressure (IOP of 8-21 mmHg or a decrease in IOP > 30%) was 89% at the last follow-up (17 +/- 15 months). Iris neovascularization regressed in 51% of eyes. Hypotonia developed in one (3%) eye (IOP of 5 mmHg). No cases of phthisis bulbi were seen. Visual acuity (VA) declined in 49% of eyes. CONCLUSIONS: A combination of transscleral contact red-laser CPC with limited anterior retinal cryocoagulation is efficient in lowering IOP in neovascular glaucoma and is well tolerated. During follow-up, a decrease in VA occurs in a significant proportion of patients.
Assuntos
Corpo Ciliar/cirurgia , Criocirurgia/métodos , Glaucoma Neovascular/cirurgia , Fotocoagulação a Laser/métodos , Retina/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Pressão Intraocular , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Estudos Retrospectivos , Esclera , Resultado do Tratamento , Acuidade VisualRESUMO
PURPOSE: To evaluate progression of visual field (VF) defects and development of visual impairment (low vision and blindness) after trabeculectomy. METHODS: We evaluated retrospectively 138 eyes of 138 consecutive patients over 40 years of age with primary open-angle glaucoma (POAG) or exfoliation glaucoma (EG) operated on by trabeculectomy without antimetabolites. The mean follow-up period was 3.5 years (range 2-5). In 83 eyes, pre- and postoperative VF measured by the same technique were compared to detect progression. Visual acuities (VA) were recorded as Snellen decimal notations. VA of <0.3 to 0.05 was defined as low vision and VA of <0.05 or VF constricted to less than 20 degrees in diameter as blindness. RESULTS: In 34 (41%) of 83 eyes with comparable fields, VF defects progressed because of glaucoma. In logistic regression analysis, severity of preoperative VF loss (P=0.0047) and use of preoperative oral anti-glaucomatous medication (P=0.047) correlated significantly with VF progression. In univariate analysis, also initial intraocular pressure (IOP) reduction after surgery (P=0.023) and IOP reduction from preoperative to last postoperative examination (P=0.036) were significantly smaller in eyes with VF progression. Defect progression did not, however, correlate significantly with the last IOP (P=0.58). Six eyes (4.3%) were blind due to glaucoma preoperatively and 14 eyes (10.1%) at the last follow-up. Visual impairment correlated with the severity of initial VF loss (P=0.008). CONCLUSIONS: Progression of VF defects and development of visual impairment due to glaucoma was fairly common despite trabeculectomy. Both were associated with severity of initial VF defect. In this series, no significant correlation appeared between defect progression and the last IOP, but association between stability of VF and the amount of IOP reduction after surgery indicate that a lower target IOP level particularly in eyes with initially severe VF defect would, however, be needed.
Assuntos
Cegueira/fisiopatologia , Glaucoma de Ângulo Aberto/fisiopatologia , Trabeculectomia , Baixa Visão/fisiopatologia , Campos Visuais , Adulto , Idoso , Cegueira/etiologia , Progressão da Doença , Feminino , Glaucoma de Ângulo Aberto/complicações , Glaucoma de Ângulo Aberto/cirurgia , Humanos , Pressão Intraocular , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Baixa Visão/etiologia , Acuidade Visual , Testes de Campo VisualRESUMO
PURPOSE: To evaluate retrospectively risk indicators for cataract surgery and the effect of phacoemulsification on intraocular pressure (IOP) control in eyes that have undergone trabeculectomy. METHODS: We undertook a retrospective analysis of 138 eyes with primary open-angle glaucoma (POAG) or exfoliation glaucoma (EG) in 138 consecutive patients over the age of 40 years undergoing trabeculectomy with no antimetabolites performed by one surgeon. Of the 48 eyes (35%) undergoing a cataract operation during the follow-up period of 2-5 years, 46 were included in this analysis. Their IOP, glaucoma medication and best corrected visual acuity (BCVA) before cataract surgery and at the last follow-up were compared. Risk indicators for cataract surgery were analysed. RESULTS: Cataract operations were performed 5.1-58.1 months (median 14.4 months) after trabeculectomy. The mean length of follow-up after cataract surgery was 25.3 months (SD 12.9, median 24.8 months). Before cataract surgery, the mean IOP was 16.2 mmHg (SD 4.9) and the mean number of topical antiglaucoma medicines 0.8 (SD 1.0). At the most recent visit, mean IOP was 17.3 mmHg (SD 6.4) (p = 0.35), and the mean number of medicines was 1.3 (SD 1.1) (p = 0.0007). Of the 22 eyes in which treatment had been categorized as completely successful (IOP < or = 21 mmHg without other therapy) before cataract surgery, 13 (59%) had remained so. The number of failures (IOP > 21 mmHg, or more than one medication needed or further surgery performed) increased from 14 (30%) before surgery to 28 (61%) afterwards. The proportion of failures in the cataract surgery group was twice that in the no cataract surgery group (61% versus 31%). In a proportional hazards regression, only age (73.9 years [SD 9.4] and 68.1 years [SD 9.8] in patients with and without cataract surgery, respectively) proved to be a significant (p = 0.001) indicator for surgery. CONCLUSION: The results of this retrospective study on consecutive clinical cases of trabeculectomy indicate that cataract progression after trabeculectomy is mainly an age-related process. In more than half the eyes with good preoperative IOP control, this good control was maintained after cataract surgery. On the other hand, in some eyes cataract surgery may compromise IOP control even when surgery avoids the area of the bleb.