Macrodisco y glaucoma en individuos estudiados con tomografía óptica coherente

Introducción: El glaucoma representa la tercera causa de ceguera a nivel mundial y un diagnóstico oportuno requiere evaluar la excavación del nervio óptico que está relacionada con el área del mismo. Existen reportes de áreas grandes (macrodiscos) que pueden ser protectoras, mientras otros las asocian a susceptibilidad para glaucoma. Objetivo: Establecer si existe asociación entre macrodisco y glaucoma en individuos estudiados con Tomografía Optica Coherente (OCT ) en la Fundación Oftalmológica Nacional. Métodos: Estudio transversal de asociación que incluyó 25 ojos con glaucoma primario de ángulo abierto y 74 ojos sanos. A cada individuo se realizó examen oftalmológico, campo visual computarizado y OCT de nervio óptico. Se compararon por grupos áreas de disco óptico y número de macrodiscos, definidos según Jonas como un área de la media más dos desviaciones estándar y según Adabache como área ≥3.03 mm2 quien evaluó población Mexicana. Resultados: El área promedio de disco óptico fue 2,78 y 2,80 mm2 glaucoma Vs. sanos. De acuerdo al criterio de Jonas, se observó un macrodisco en el grupo sanos y según criterio de Adabache se encontraron ocho y veinticinco macrodiscos glaucoma Vs. sanos. (OR=0,92 IC95%=0.35 – 2.43). Discusión: No hubo diferencia significativa (P=0.870) en el área de disco entre los dos grupos y el porcentaje de macrodiscos para los dos grupos fue similar, aunque el bajo número de éstos no permitió concluir en términos estadísticos sobre la presencia de macrodisco y glaucoma.

Efeito da brimonidina na circulação retrobulbar em pacientes com glaucoma: estudo com Doppler colorido

Objetivo: Avaliar o efeito do tartarato de brimonidina a 0,2% tópico, instilado de 12/12 horas, na circulação retrobulbar em pacientes portadores de glaucoma. Métodos: Foram estudados os 2 olhos de 16 pacientes portadores de glaucoma primário de ângulo aberto e glaucoma crônico de ângulo estreito com iridotomia. Usando o Doppler colorido foram avaliados: velocidade sistólica máxima, velocidade diastólica final e índice de resistência das artéria central da retina, artéria ciliar posterior curta temporal e artéria oftálmica. As avaliações foram feitas antes e depois do uso da brimonidina. Resultados: O tartarato de brimonidina a 0,2% aumentou significativamente a velocidade sistólica máxima (28,24 para 34,23 cm/seg) e velocidade diastólica final (6,62 para 8,10 cm/seg) no olho direito e reduziu o índice de resistência (0,75 para 0,71) no olho esquerdo da artéria oftálmica. Conclusão: O tartarato de brimonidina 0,2% 2x/dia aumentou significativamente a velocidade sistólica máxima e velocidade diastólica final e reduziu índice de resistência da artéria oftálmica de pacientes glaucomatosos. Este efeito sugere que a brimonidina pode beneficiar pacientes glaucomatosos com insuficiência vascular na cabeça do nervo óptico.

Estudo do comportamento da PIO de 24 horas e frequência de glaucoma em pacientes com síndrome da apnéia obstrutiva do sono

Purpose: To determine the frequency of glaucoma and evaluate the behavior of 24-hour intraocular pressure in patients with the obstructive sleep apnea syndrome (OSAS). Methods: Eleven consecutive patients with OSAS, diagnosed by polysonography, were avaliated in a cross-sectional study. Demographic data were analyzed: age, sex, race/color, weight, height and associated diseases. The patients were submitted to complete ophthalmologic examination, including the visual field, as well as to 24-hour intra-ocular pressure (IOP) evaluation by an applanation tonometer at 9h, 12h, 15h, 18h, 24h and 6h in the lying and sitting positions. The diagnostic criterion for glaucoma was alteration of the visual field (VF) compatible with glaucoma and one or more of the following alterations: cup-disc ratio >= 0.7, hemorrhage, wedge-shaped defect, bayonet-shaped vessels, Hoyt's sign, asymmetry > than 0.2 between cup/disc ratio of the eyes. The angle should be opened without alterations. Results: 9 (82%) of 11 patients showed glaucoma or were suspected to have glaucoma, 9% of which exhibited normal tension glaucoma and 73% were suspected to have glaucoma for presenting alterations in the optic nerve or ocular hypertension. The mean for the IOP values of the 11 patients was observed to be the highest at 6 o'clock, when they were lying down. Variations of IOP >= 5 mmHg occurred in 7 (64%) of the patients, and variations of up to 14 mmHg and IOP peaks of up to 32 mmHg were observed. Conclusion: OSAS may be an important risk factor for the development of glaucoma, particularly that of normal tension glaucoma. Patients with OSAS must be referred to an ophthalmologist and those professionals must be attentive to the association of sleep disorders in patients with open-angle glaucoma.

Avaliação clínica da ablação uveal intravítrea com gentamicina em cães portadores de glaucoma crônico

Investigou-se, clinicamente o resultado da ablação uveal intravítrea em 13 olhos cegos de cães com glaucoma crônico unilateral. Os olhos acometidos foram submetidos à ablação uveal intravítrea, por meio de injeção na câmara vítrea de 0,5ml de sulfato de gentamicina (40mg/ml) associado a 0,3ml de fosfato de dexametasona (4mg/ml). As variáveis clinicas oftálmicas foram quali-quantificadas em escores, por até 48 semanas do pós-operatório; além de aspectos relacionados à dor, como variações do apetite e peso corporal. Nos sinais clínicos, de secreção ocular, blefaroespasmo, quemose, hifema e pigmentação, neovascularização, pannus e variações de apetite e peso corporal, não se notaram diferenças significativas entre os momentos. A ablação uveal intravítrea diminuiu a hiperemia conjuntival, porém acarretou aumento de opacidade corneana. A associação da ablação com antiinflamatórios tópico e sistêmico indicou não se tratar de procedimento doloroso.

The value of intraocular pressure asymmetry in diagnosing glaucoma

PURPOSE

Glaucoma secundário em cães e gatos

Glaucoma is a syndrome that affects animals of different species and in different moments of his life, having variables causes in function of this presentation. It is an ophthalmic emergency that may develop irreversible vision damage as well as the patient's aesthetic presentation. Increased intraocular pressure, presence of engorged episcleral vessels, conjunctival hyperemia, pain, anterior uveitis, lens luxation and buftalmia are commonly clinical signs presented by dogs while in cats, signs are less expressive, noting mydriasis, mild ciliary injection and progressive buftalmia. For diagnosis are carried out three basic procedures: tonometry, gonioscopy and ophthalmoscopy. The treatment can establish with medical therapy with or without surgical intervention, however, at some point it will be necessary to perform enucleation or evisceration of the eye bulb.

Efeitos do citrato de sildenafila sobre a neuroproteção na neuropatia óptica, em ratos (Lewis/SsNHsd) com glaucoma agudo

Pós-graduação em Cirurgia Veterinária - FCAV

Safety and efficacy of fixed-combination travoprost/timolol in patients with open-angle glaucoma or ocular hypertension not controlled with timolol monotherapy

To assess the intraocular pressure (IOP)-lowering effect of travoprost 0.004%/timolol 0.5% fixed-dose combination (TRAV/TIM-FC) in patients not achieving the target IOP of ≤18 mmHg while on timolol 0.5% (TIM) monotherapy. A multicenter, prospective, open-label study (NCT01336569) was conducted in patients with open-angle glaucoma or ocular hypertension. Eligible patients were receiving TIM monotherapy with a screening/baseline IOP of 19-35 mmHg in ≥1 eye. TIM was discontinued on the baseline visit day (no washout period) and TRAV/TIM-FC was initiated and administered once daily at 8 pm for 4-6 weeks. The primary efficacy variable was mean change in IOP from TIM-treated baseline to study end, measured by Goldmann applanation tonometry. Results were analyzed by analysis of variance and paired samples t-test (5% significance). A total of 49 patients were enrolled (mean age, 63 [range, 42-82] years; 55.1% White; 73.5% women), and 45 were included in the intent-to-treat (ITT) population. Mean duration of treatment with TRAV/TIM-FC was 31 days. Mean ± standard deviation IOP reduction from baseline (TIM) to the follow-up visit (TRAV/TIM-FC) was -5.0±3.6 mmHg. IOP decreased significantly (P<0.0001) from baseline (22.1±2.6 mmHg) to study end (17.1±3.9 mmHg) in the ITT population, with a mean IOP reduction of 22.3%. Most patients (n=33/45; 73.3%) achieved IOP ≤18 mmHg. Two patients experienced a total of four adverse events (AEs), including a patient who reported one serious AE (enterorrhagia) that was considered unrelated to treatment, and a patient who reported one event each of drug-related redness, pruritus, and foreign body sensation. Most patients (n=47/49; 95.9%) reported no AEs. TRAV/TIM-FC lowered IOP in patients who were not at target IOP while receiving TIM monotherapy, with most patients achieving an IOP ≤18 mmHg with TRAV/TIM-FC. TRAV/TIM-FC was well tolerated in this population.

Experimental glaucoma model (ischemia and reperfusion): histology, morphometry, protein and gene espression of apoptosis pathway

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Reprodutibilidade da curva de pressão intraocular de 24 horas em pacientes com glaucoma e suspeita de glaucoma

Pós-graduação em Bases Gerais da Cirurgia - FMB

Heterochromatic Flicker Electroretinograms Reflecting Luminance and Cone Opponent Activity in Glaucoma Patients

PURPOSE. To measure heterochromatic flicker electroretinograms (ERGs) at high (36 Hz) and intermediate (12 Hz) temporal frequencies to evaluate luminance and cone opponent responses, respectively, in glaucoma eyes with (perimetric) and without (preperimetric) visual field defects. METHODS. Flicker ERGs were recorded from one randomly chosen dilated eye of 32 patients (mean age, 61 +/- 11 years; 15 men, 17 women) from the Erlangen Glaucoma Registry and from 24 healthy volunteers (mean age, 43 +/- 11 years; 14 men, 10 women). Red and green light-emitting diodes in a Ganzfeld stimulator were sine wave-modulated in counterphase. The responses were measured at 36 Hz, the frequency at which ERGs reflect activity of the luminance pathway, and at 12 Hz, the frequency at which ERGs reflect chromatic activity. RESULTS. Response amplitudes were similar in glaucoma patients and controls. Phase differences were observed in patients with visual field defects (perimetric) compared with the control group at 36 and 12 Hz in the first harmonic and second harmonic responses. Patients without visual field defects (preperimetric) showed phase differences for the second harmonic component at 36 Hz. No age effect on response amplitudes and phases was found in any of the subject groups (controls and patients). CONCLUSIONS. The responses displayed phase differences but not amplitude differences in perimetric glaucoma patients at both 36 and 12 Hz, suggesting that both magnocellular and parvocellular pathways are affected. Preperimetric glaucoma patients also showed phase differences. The response phase may be sensitive to early dysfunction of the inner retina. (ClinicalTrials.gov number, NCT00494923.) (Invest Ophthalmol Vis Sci. 2011;52:6757-6765) DOI:10.1167/iovs.11-7538

Conjunctival inflammation in patients under topical glaucoma treatment with indication to surgery

PURPOSE: To compare the frequency of conjunctival HLA-DR expression (a surrogate marker for inflammation) in eyes treated with topical prostaglandin analogues versus eyes treated with other topical antiglaucomatous drugs. METHODS: Patients diagnosed with primary open-angle glaucoma presenting indication for trabeculectomy were divided in groups according to the use or not of prostaglandin analogues. All subjects were treated with the maximum tolerated dose of antiglaucomatous drugs until the date of the surgery. At the beginning of the surgical procedure, a 5 x 5 mm biopsy of the bulbar conjunctiva was collected, incubated with monoclonal anti-HLA-DR antibody and processed for histological analysis. RESULTS: Of the 31 eyes included (31 patients), 25 were under topical prostaglandin analogues (Group 1) and six under other topical pharmacological agents (Group 2). Fourteen eyes of Group 1 (56%) and three of Group 2 (50 %) were positive for the inflammatory marker HLA-DR (P=1.0). The percentage of stained cells ranged from 15.49 to 48.09% (median: 27.61) in Group 1, and from 18.35 to 28 (median: 20.71) in Group 2, with no differences statistically significant (p=0.33). CONCLUSION: The use of prostaglandin analogues did not increase conjunctival expression of HLA-DR compared to other topical antiglaucomatous agents.

Association of polymorphisms of endothelial nitric oxide synthase (eNOS) gene with the risk of primary open angle glaucoma in a Brazilian population

The present study aimed to investigate the association of endothelial nitric oxide synthase (eNOS) gene polymorphisms with primary open angle glaucoma (POAG). We conducted a case-control study that included 90 patients with POAG and 127 healthy controls whose blood samples were genotyped for the functional polymorphisms T-786C and Glu298Asp of the eNOS gene by Taqman fluorescent allelic discrimination assay. The T-786C polymorphism was significantly associated as a risk factor for POAG among women (OR: 228; 95% CI: 1.11 to 4.70, p = 0.024) and marginally associated to the risk of POAG in the patients >= 52 years of age at diagnosis (OR: 2.11; 95% CI: 0.98 to 4.55, p = 0,055). However, these results was not confirmed after adjustments for gender, age, self-declared skin color, tobacco smoking and eNOS genotypes by multivariate logistic regression model (OR: 2.08; 95% CI: 0.87 to 5.01, p = 0.101 and OR: 2.20; 95% CI: 0.95 to 5.12, p = 0.067, respectively). The haplotype CG of T-786C and Glu298Asp showed a borderline association with risk of POAG in the overall analysis (OR: 1.76; 95% CI: 0.98 to 3.14, p = 0.055) and among women (OR: 2.02; 95% CI: 0.98 to 4.16, p = 0.052). Furthermore, the CG haplotype was significantly associated with the development of POAG for the age at diagnosis group >= 52 years (OR: 3.48; 95% CI: 1.54 to 7.84, p = 0.002). We suggested that haplotypes of the polymorphisms T-786C and Glu298Asp of eNOS may interact with gender and age in modulating the risk of POAG. (C) 2012 Elsevier B.V. All rights reserved.

Laminar Displacement and Prelaminar Tissue Thickness Change after Glaucoma Surgery Imaged with Optical Coherence Tomography

PURPOSE. To study changes in lamina cribrosa position and prelaminar tissue thickness (PTT) after surgical IOP reduction in glaucoma patients. METHODS. Twenty-two patients (mean age, 71.4 years) were imaged with spectral domain optical coherence tomography (SD-OCT; 24 radial B-scans centered on the optic nerve head [ONH]) before trabeculectomy or tube shunt implantation. Follow up images were acquired 1 week, 1 month, 3 months, and 6 months postsurgery. Bruch's membrane opening (BMO), the internal limiting membrane (ILM) and the anterior laminar surface (ALS) were segmented in each radial scan with custom software. Surfaces were fitted to the ILM and ALS with the extracted three-dimesional coordinates. PTT was the distance between the ILM and ALS, perpendicular to a BMO reference plane. Serial postsurgical laminar displacement (LD), relative to the BMO reference plane, and changes in PTT were measured. Positive values indicated anterior LD. RESULTS. Mean (SD) presurgery IOP was 18.1 (6.5) mm Hg, and reduced by 4.7 (5.5), 2.4 (7.7), 7.0 (6.2), and 6.8 (7.5) mm Hg at 1 week, 1 month, 3 months, and 6 months postsurgery, respectively. At the four postsurgery time points, there was significant anterior LD (1.8 [9.5], -1.1 [8.9], 8.8 [20.2], and 17.9 [25.8] mu m) and PTT increase (1.7 [13.3], 2.4 [11.9], 17.4 [13.7], and 13.9 [18.6] mu m). LD was greater in ONHs with larger BMO area (P = 0.01) and deeper ALS (P = 0.04); however, PTT was not associated with any of the tested independent variables. CONCLUSIONS. Both anterior LD and thickening of prelaminar tissue occur after surgical IOP reduction in patients with glaucoma. (Invest Ophthalmol Vis Sci. 2012;53:5819-5826) DOI:10.1167/iovs.12-9924