1
|
Vieira JM, de Miranda Cordeiro F, Kanadani FN, Prata TS. Letter to the Editor: Longitudinal Assessment of Retinal Nerve Fiber Layer and Ganglion Cell Complex Thicknesses in Patients With Large Optic Disc Cups and Normal Intraocular Pressure and Visual Fields. J Glaucoma 2023; 32:e161. [PMID: 37671573 DOI: 10.1097/ijg.0000000000002305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/07/2023]
Affiliation(s)
- Júlia M Vieira
- Department of Ophthalmology of Glaucoma Institute, Belo Horizonte Minas Gerais
| | - Frederico de Miranda Cordeiro
- Department of Ophthalmology of Glaucoma Institute, Belo Horizonte Minas Gerais
- Hospital Medicina dos Olhos, Opty Group
| | - Fábio N Kanadani
- Department of Ophthalmology of Glaucoma Institute, Belo Horizonte Minas Gerais
- Mayo Clinic, Jacksonville, FL
| | - Tiago S Prata
- Hospital Medicina dos Olhos, Opty Group
- Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil
- Mayo Clinic, Jacksonville, FL
| |
Collapse
|
2
|
Samico GA, Abe RY, Prata TS, Teixeira SH, Paranhos A, Gracitelli CPB. Relationship between the number of glaucoma medications, ocular surface disorder, and treatment adherence. Arq Bras Oftalmol 2023; 87:e20210525. [PMID: 37851737 DOI: 10.5935/0004-2749.2021-0525] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 12/20/2022] [Indexed: 04/03/2023] Open
Abstract
PURPOSE To determine the relationship of ocular surface disease, the number of glaucoma medications prescribed and its influence on treatment adherence. METHODS In this cross-sectional study, demographic data of patients with glaucoma were collected, and patients completed the ocular surface disease index questionnaire and the glaucoma treatment compliance assessment tool. Ocular surface parameters were assessed by "Keratograph 5M." Patients were stratified into two groups according to the amount of prescribed ocular hypotensive eye drops (Group 1, one or two classes of medications; Group 2, three or four classes). RESULTS In total, 27 eyes of 27 patients with glaucoma were included: 17 using 1 or 2 topical medications (Group 1) and 10 eyes using 3 or 4 classes (Group 2). For the Keratograph assessment, patients using ≥3 medications had significantly smaller tear meniscus height (0.27 ± 0.10 vs. 0.43 ± 0.22; p=0.037). The analysis of Ocular Surface Disease Index questionnaire showed higher scores among the groups using more hypotensive eye drops (18.67 ± 13.53 vs. 38.82 ± 19.72; p=0.004). Regarding the glaucoma treatment compliance assessment tool, Group 2 had worse scores in components of forgetfulness (p=0.027) and barriers due to lack of drops (p=0.031). CONCLUSION Patients with glaucoma using more hypotensive eye drops had worse tear meniscus height and ocular surface disease index scores than those using fewer topical medications. Patients using three or four drug classes had worse predictors of glaucoma adherence. Despite worse ocular surface disease results, no significant difference in self-reported side effects was found.
Collapse
Affiliation(s)
- Gustavo A Samico
- Department of Ophthalmology and Visual Science, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Ricardo Y Abe
- Hospital Oftalmológico de Brasília, Brasília, DF, Brazil
| | - Tiago S Prata
- Department of Ophthalmology and Visual Science, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Sergio Henrique Teixeira
- Department of Ophthalmology and Visual Science, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Augusto Paranhos
- Department of Ophthalmology and Visual Science, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | | |
Collapse
|
3
|
Taniguchi EV, Almeida INF, Gracitelli CPB, Agapito C, Zett C, Sant'Ana L, Kayser C, Prata TS, Paranhos A. Peripheral Microvascular Abnormalities Associated with Open-Angle Glaucoma. Ophthalmol Glaucoma 2023; 6:291-299. [PMID: 36307064 DOI: 10.1016/j.ogla.2022.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 09/20/2022] [Accepted: 10/12/2022] [Indexed: 05/26/2023]
Abstract
PURPOSE To investigate peripheral microvascular abnormalities associated with patients with open-angle glaucoma (OAG). DESIGN This was a cross-sectional study. PARTICIPANTS Patients with OAG and controls. METHODS All subjects underwent detailed ophthalmic evaluation, including Humphrey visual field (HVF) tests and swept source OCT. To evaluate peripheral microvascular abnormalities, nailfold capillaroscopy (NFC) and laser Doppler imaging (LDI) were performed. The presence of microhemorrhages, tortuous capillaries, dilated capillaries, avascular areas, and the capillary density, among other characteristics, were recorded using NFC; fingertip blood flow (FBF) was measured using LDI at different time points, before and 1, 10, and 20 minutes after exposure to a cold stimulus. In addition, venous blood samples were collected to measure serum endothelin-1 (ET-1) concentrations as well as serum autoantibodies. MAIN OUTCOME MEASURES Presence of microhemorrhages, tortuous capillaries, and dilated capillaries; FBF; ET-1; and autoantibodies. RESULTS Sixty-eight subjects (43 patients with OAG and 25 controls) were enrolled in the study. Microhemorrhages were found in the nail bed of 65.1% of the patients with OAG compared with 25.0% of the controls (P = 0.003). There was a significant difference in the mean FBF at the baseline in patients with OAG versus controls (293.6 ± 100.2 vs 388.8 ± 52.0 perfusion units, respectively, P < 0.001), together with a significant decrease in the mean FBF 10 and 20 minutes after cold stimulus in patients with OAG in comparison to controls (P < 0.001 for all comparisons). There was a positive correlation between mean baseline FBF and HVF mean deviation (r = 0.27, P = 0.03) and between mean baseline FBF and average retinal nerve fiber layer thickness (r = 0.44, P = 0.001). Neither the analysis of ET-1 concentrations (P= 0.71) nor the autoantibodies measurements (P > 0.05, for all) showed any difference between the 2 groups. CONCLUSIONS Significant peripheral microvascular abnormalities were found in patients with OAG compared to controls, suggesting that microvascular changes might play a role in the pathogenesis of the disease. In addition, part of these peripheral microvascular abnormalities seems to be correlated with both functional and structural glaucomatous damage. FINANCIAL DISCLOSURE(S) The author(s) have no proprietary or commercial interest in any materials discussed in this article.
Collapse
Affiliation(s)
- Elise V Taniguchi
- Department of Ophthalmology and Visual Science, Glaucoma Service, Federal University of São Paulo, São Paulo, Brazil; Hospital de Olhos de Blumenau, Blumenau, Brazil
| | - Izabela N F Almeida
- Department of Ophthalmology and Visual Science, Glaucoma Service, Federal University of São Paulo, São Paulo, Brazil
| | - Carolina P B Gracitelli
- Department of Ophthalmology and Visual Science, Glaucoma Service, Federal University of São Paulo, São Paulo, Brazil; Centro de Estudos Alcides Hirai, Ver Mais Oftalmologia, Vinhedo, São Paulo, Brazil.
| | - Cecília Agapito
- Department of Rheumatology, Federal University of São Paulo, São Paulo, Brazil
| | - Claudio Zett
- Department of Ophthalmology and Visual Science, Glaucoma Service, Federal University of São Paulo, São Paulo, Brazil; Facultad de Ciencias, Pontificia Universidad Católica de Valparaíso, Valparaíso, Chile
| | - Letícia Sant'Ana
- Department of Ophthalmology and Visual Science, Glaucoma Service, Federal University of São Paulo, São Paulo, Brazil
| | - Cristiane Kayser
- Department of Rheumatology, Federal University of São Paulo, São Paulo, Brazil
| | - Tiago S Prata
- Glaucoma Unit, Hospital Medicina dos Olhos, Osasco, Brazil; Department of Ophthalmology, Mayo Clinic, Jacksonville, Florida; Department of Ophthalmology, Glaucoma Service, Hospital Oftalmológico de Sorocaba - BOS, Sorocaba, Brazil
| | - Augusto Paranhos
- Department of Ophthalmology and Visual Science, Glaucoma Service, Federal University of São Paulo, São Paulo, Brazil
| |
Collapse
|
4
|
Kanadani FN, de F Campos L, Dorairaj S, Prata TS. Transscleral Cyclophotocoagulation: New Perspectives for Uncontrolled Glaucoma Management. J Curr Glaucoma Pract 2023; 17:1-2. [PMID: 37228313 PMCID: PMC10203331 DOI: 10.5005/jp-journals-10078-1398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Abstract
How to cite this article: Kanadani FN, F Campos LD, Dorairaj S, et al. Transscleral Cyclophotocoagulation: New Perspectives for Uncontrolled Glaucoma Management. J Curr Glaucoma Pract 2023;17(1):1-2.
Collapse
Affiliation(s)
- Fabio N Kanadani
- Department of Ophthalmology, Glaucoma Institute, Belo Horizonte, Minas Gerais, Brazil; Department of Ophthalmology, Mayo Clinic, Jacksonville, Florida, United States of America; Department of Ophthalmology, Federal University of São Paulo, São Paulo, SP, Brazil
| | - Lilian de F Campos
- Department of Ophthalmology, Glaucoma Institute, Belo Horizonte, Minas Gerais, Brazil
| | - Syril Dorairaj
- Department of Ophthalmology, Mayo Clinic, Jacksonville, Florida, United States of America
| | - Tiago S Prata
- Department of Ophthalmology, Glaucoma Institute, Belo Horizonte, Minas Gerais, Brazil; Department of Ophthalmology, Mayo Clinic, Jacksonville, Florida, United States of America; Department of Ophthalmology, Federal University of São Paulo, São Paulo, SP, Brazil; Glaucoma Sector, HMO, Opty Group, Brazil
| |
Collapse
|
5
|
Faria BM, Costa VP, Melillo GHL, Daga FB, Scoralick ALB, Paranhos A, Kanadani FN, Prata TS. Gonioscopy-Assisted Transluminal Trabeculotomy for Glaucoma: 1-Year Outcomes and Success Predictors. J Glaucoma 2022; 31:443-448. [PMID: 35353767 DOI: 10.1097/ijg.0000000000002025] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 03/17/2022] [Indexed: 11/25/2022]
Abstract
PRCIS Our results suggest gonioscopy-assisted transluminal trabeculotomy (GATT) as an effective and safe option for the surgical management of open-angle glaucoma (OAG). Older age was the only risk factor for failure in our analysis. PURPOSE To report 12-month clinical outcomes, safety profile and success predictors of GATT in patients with OAG. PATIENTS AND METHODS A retrospective study of patients (18 y old and above) with medically uncontrolled OAG who underwent GATT as a solo procedure or combined with phacoemulsification (PHACO-GATT) between January 2018 and January 2020. Success at 12 months (primary outcome) was defined as intraocular pressure (IOP) <15 mm Hg, with an IOP reduction of at least 20%, OR a reduction of at least 2 glaucoma medications, compared with baseline. Secondary outcomes were success predictors and safety parameters. RESULTS A total of 73 eyes (GATT=38; PHACO-GATT=35) from 58 patients with a mean age of 54.8±11.6 years were included. Overall, after 12 months of follow-up, the mean IOP was reduced from 24.9±8.5 to 12.1±2.1 mm Hg (P<0.001). The mean number of glaucoma medications was reduced from 3.5±0.7 to 1.2±1.2 (P<0.001). The success rate was 87% at 12 months, with no significant differences between GATT (85%) and PHACO-GATT (91%) eyes (P=0.330). Age was the only factor significantly associated with surgical success (hazard ratio=1.35; P=0.012; after adjusting for preoperative IOP and number of glaucoma medications). Patients older than 60 years had a significant greater chance of failure (hazard ratio=10.96; P=0.026) compared with those younger than 60 years. The most common postoperative complication was transient hyphema (39%; median duration, 5 d). No sight-threatening adverse event was documented. CONCLUSIONS GATT was effective and safe at lowering IOP with or without cataract extraction in OAG. Patients 60 years or older had a higher risk of failure compared with those younger in age.
Collapse
Affiliation(s)
- Bruno M Faria
- Department of Ophthalmology, Federal University of Rio Grande do Norte, Natal
| | | | - Gustavo H L Melillo
- College of Medicine & Veterinary Medicine, The University of Edinburgh, Edinburgh, Scotland
| | - Fabio B Daga
- Department of Ophthalmology, Federal University of São Paulo, São Paulo
| | - Ana L B Scoralick
- Department of Ophthalmology, Federal University of São Paulo, São Paulo
- Glaucoma Institute, Belo Horizonte, Brazil
| | - Augusto Paranhos
- Department of Ophthalmology, Federal University of São Paulo, São Paulo
| | - Fábio N Kanadani
- Department of Ophthalmology, Federal University of São Paulo, São Paulo
- Glaucoma Institute, Belo Horizonte, Brazil
- Department of Ophthalmology, Mayo Clinic, Jacksonville, Florida
| | - Tiago S Prata
- Department of Ophthalmology, Federal University of São Paulo, São Paulo
- Glaucoma Institute, Belo Horizonte, Brazil
- Department of Ophthalmology, Mayo Clinic, Jacksonville, Florida
| |
Collapse
|
6
|
Dias DT, Almeida I, Ushida M, Lopes FS, Kanadani FN, Gracitelli CPB, Prata TS. Subtenon triamcinolone as an adjuvant in mitomycin-C-enhanced trabeculectomy in non-inflammatory glaucomas: A randomized clinical trial. PLoS One 2022; 17:e0268623. [PMID: 35617211 PMCID: PMC9135266 DOI: 10.1371/journal.pone.0268623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 04/04/2022] [Indexed: 11/18/2022] Open
Abstract
This unicentric randomized clinical trial was designed to compare the surgical outcomes of mitomycin C-enhanced trabeculectomy (MMC-TRAB) with and without subtenon triamcinolone acetonide (TAAC) injection in patients with non-inflammatory glaucomas. This trial is registered at the Brazilian Registry of Clinical Trials (ReBEC) under the register number RBR-53f8nh. Consecutive non-inflammatory glaucoma patients requiring surgical intervention were randomized into two groups. In the control group, eyes underwent standard MMC-TRAB, while in the intervention group, besides the standard MMC-TRAB, these eyes also received a subtenon TAAC injection (4mg) close to the bleb site at the end of the surgery. The main outcomes of the study were surgical success rates, intraocular pressure (IOP) and number of medications at all timepoints. Success was defined as IOP ≤ 15 mmHg and subdivided in complete or qualified according to the need of medication. A total of 75 eyes of 63 different patients were included (intervention group = 39 eyes; control group = 36 eyes). There was no difference between groups at baseline (p>0.11). Multivariable regression analysis indicated that IOP levels were significantly lower in the intervention group at 18 and 24 months of follow-up when number of medications was considered as a covariate (P<0.001). Complete success rates were higher in the intervention group at 06 (90.9% vs 68.7%; p = 0.03), 12 (87.2% vs 66.7%; p = 0.02) and 18 months (87.2% vs 66.7%; p = 0.02). Additionally, although success rates at 24 months were higher in the intervention group (82.0% vs 66.7%; p = 0.09), this difference did not reach statistical significance. Qualified success rates did not significantly differ between groups at all timepoints. In conclusion, this study found significantly lower IOPs levels at 18 and 24 months of follow-up and higher complete success rates until 18 months of follow-up, with the use of subtenon TAAC as an adjuvant to standard MMC-TRABs in non-inflammatory glaucoma patients.
Collapse
Affiliation(s)
- Diego T. Dias
- Department of Ophthalmology, Federal University of São Paulo, São Paulo, São Paulo, Brazil
- Glaucoma Department, Hospital de Olhos de Sergipe, Aracaju, Sergipe, Brazil
- * E-mail:
| | - Izabela Almeida
- Department of Ophthalmology, Federal University of São Paulo, São Paulo, São Paulo, Brazil
| | - Michele Ushida
- Glaucoma Unit, Hospital Medicina dos Olhos, Osasco, São Paulo, Brazil
| | - Flavio S. Lopes
- Department of Ophthalmology, Federal University of São Paulo, São Paulo, São Paulo, Brazil
| | - Fábio N. Kanadani
- Department of Ophthalmology, Federal University of São Paulo, São Paulo, São Paulo, Brazil
| | | | - Tiago S. Prata
- Department of Ophthalmology, Federal University of São Paulo, São Paulo, São Paulo, Brazil
- Glaucoma Unit, Hospital Medicina dos Olhos, Osasco, São Paulo, Brazil
- Department of Ophthalmology, Hospital Oftalmológico de Sorocaba, Sorocaba, São Paulo, Brazil
| |
Collapse
|
7
|
Almeida INF, Dias DT, Alhadeff PA, Lopes FSS, Paranhos A, Ritch R, Gracitelli CPB, Prata TS. Clinical Profiles of Glaucomatous Patients With High-tension and Low-tension Optic Disc Hemorrhages: A Comparative Study. J Glaucoma 2022; 31:178-182. [PMID: 34506356 DOI: 10.1097/ijg.0000000000001937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 08/24/2021] [Indexed: 11/26/2022]
Abstract
PRCIS Patients with low-tension optic disc hemorrhages (DHs) are more frequently women, have a diagnosis of normal-tension glaucoma (NTG) diagnosis and greater visual field (VF) loss. Symptoms of vascular dysregulation and Asian race also seem to be more prevalent in this clinical subtype. PURPOSE Optic DH is an important glaucoma risk factor, and occurs in a wide intraocular pressure (IOP) range. We sought to characterize distinct clinical subtypes of patients with high-tension disc hemorrhage (HTDH) and low-tension disc hemorrhage (LTDH). PATIENTS AND METHODS In this cross-sectional study, treated glaucomatous patients with DHs from 2 glaucoma services were consecutively enrolled. Disc photographs were evaluated for the presence of DH by 2 glaucoma specialists. After inclusion, patients were classified on HTDH (IOP≥16 mm Hg) and LTDH (IOP<16 mm Hg; median split). Clinical and ocular data from the time of DH detection were compared between groups. RESULTS One hundred thirty-three DH patients were included (LTDH=66 eyes; HTDH=67 eyes). Patients with LTDH were more often women than those with HTDH (77% vs. 42%; P=0.030). There was also a trend for a higher prevalence of Asian descendants (24% vs. 9%; P=0.058) and symptoms suggestive of vascular dysregulation (34% vs. 14%; P=0.057) in LTDH patients. Eyes with LTDH also had worse VF mean deviation index (P=0.037), higher prevalence of NTG diagnosis (46% vs. 17%; P<0.001), and tended to have thinner central corneas (P=0.066). CONCLUSIONS Patients developing DHs with treated IOPs in the low teens seem to more frequently fit in a profile represented by women, NTG diagnosis and greater VF loss. The presence of symptoms suggestive of vascular dysregulation and race also seem to differ between these 2 clinical subtypes. A closer optic disc surveillance is recommended for patients with the LTDH subtype, as they may develop DHs despite seemingly well-controlled IOP.
Collapse
Affiliation(s)
| | - Diego T Dias
- Department of Ophthalmology, Federal University of Sao Paulo, Sao Paulo
- Glaucoma Unit, Hospital Medicina dos Olhos, Osasco, SP, Brazil
| | - Paula A Alhadeff
- Einhorn Clinical Research Center, New York Eye and Ear Infirmary of Mount Sinai, New York, NY
| | - Flavio S S Lopes
- Department of Ophthalmology, Federal University of Sao Paulo, Sao Paulo
| | - Augusto Paranhos
- Department of Ophthalmology, Federal University of Sao Paulo, Sao Paulo
| | - Robert Ritch
- Einhorn Clinical Research Center, New York Eye and Ear Infirmary of Mount Sinai, New York, NY
| | | | - Tiago S Prata
- Department of Ophthalmology, Federal University of Sao Paulo, Sao Paulo
- Glaucoma Unit, Hospital Medicina dos Olhos, Osasco, SP, Brazil
- Department of Ophthalmology, Mayo Clinic, Jacksonville, FL
| |
Collapse
|
8
|
Abe RY, Maestrini HA, Guedes GB, Nascimento MM, Iguma CI, de Miranda Santos HD, Nasr MG, Lucena-Junior RP, Prata TS. Real-world data from selective laser trabeculoplasty in Brazil. Sci Rep 2022; 12:1923. [PMID: 35121762 PMCID: PMC8817042 DOI: 10.1038/s41598-022-05699-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 01/17/2022] [Indexed: 11/09/2022] Open
Abstract
Evaluate real-world data of outcomes from selective laser trabeculoplasty (SLT) performed in different regions of Brazil and investigate potential predictors of success associated with treatment. Multicenter retrospective case series with patients who underwent a primary SLT procedure. A total of 835 eyes from 835 patients were included. The mean follow-up was 916.8 ± 563.0 days. The mean age was 64.5 ± 14.9 years and 56.6% were women. We observed an intraocular pressure reduction comparing baseline to post-SLT measurements (18.4 ± 3.8 mmHg versus 14.8 ± 3.5 mmHg; P < 0.001) and mean number of glaucoma medications (1.8 ± 1.3 versus 1.4 ± 1.4; P < 0.001). We observed visual acuity loss over time (0.1 ± 0.3 versus 0.2 ± 0.3 logMAR, baseline and post-SLT, respectively, P = 0.009) and decrease in visual field mean deviation values (- 5.4 ± 5.9 versus - 5.7 ± 6.0 dB; P = 0.054) The Kaplan-Meier survival analysis showed an estimated probability of treatment success of 88% at 12 months, declining to 70% at 24 months and 54% at 36 months post-SLT. In the multivariable model, we found that a denser angle pigmentation (HR 0.69; 95% CI 0.57-0.85, P = 0.001) and corticosteroid treatment following SLT (HR 0.59; 95% CI 0.39-0.91, P = 0.018) were significantly associated with a lower risk for failure. Primary SLT achieved relatively high success rates without sight-threating complications in this real-world study with a large sample of Brazilian patients. These findings corroborate previous studies regarding SLT outcomes and may help clinicians to identify the best candidates for laser treatment.
Collapse
Affiliation(s)
- Ricardo Y Abe
- Hospital Oftalmológico de Brasília, SGAS 607 Avenida L2 Sul, Distrito Federal, Brasília, ZIP Code 70200670, Brazil. .,Department of Ophthalmology - University of Campinas, Campinas, Brazil.
| | | | | | | | - Camila I Iguma
- Hospital Oftalmológico de Brasília, SGAS 607 Avenida L2 Sul, Distrito Federal, Brasília, ZIP Code 70200670, Brazil
| | | | | | | | - Tiago S Prata
- Hospital Medicina Dos Olhos, Osasco, São Paulo, Brazil.,Departamento de Oftalmologia, UNIFESP/EPM, São Paulo, Brazil
| |
Collapse
|
9
|
Agapito Tito CV, Silvatti J, de Almeida INF, Taniguchi EV, Prata TS, Paranhos A, Kayser C. Structural abnormalities associated with glaucoma using swept-source optical coherence tomography in patients with systemic sclerosis. Int Ophthalmol 2021; 42:1369-1380. [PMID: 34822051 DOI: 10.1007/s10792-021-02124-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 11/12/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE Vasospasm represents an early event in systemic sclerosis (SSc). Ocular vasospasm may induce optic nerve head (ONH) damage and has been involved in the pathogenesis of glaucoma, especially normal-tension glaucoma (NTG). We aimed to investigate the presence of structural abnormalities associated with NTG using swept-source optical coherence tomography (SS-OCT) and to correlate the OCT parameters with clinical, capillaroscopy and digital blood flow measures in patients with SSc. METHODS In this cross-sectional study, 40 patients with SSc and 23 age-matched controls were included. The following parameters were measured using SS-OCT: mean and sectoral retinal nerve fibre layer (RNFL) thickness, macular ganglion cell layer complex (GCC) thickness and ONH morphology. Nailfold capillaroscopy (NFC) and digital blood flow measurements using laser Doppler imaging (LDI) were performed in all subjects. RESULTS Patients with SSc showed a thinner temporal RNFL than the controls (69.23 ± 11.74 versus 83.35 ± 20.19 µm, p = 0.001). The other parameters were similar between the two groups. In SSc patients, there was an inverse correlation between the disease duration and the average, superior and inferior RNFL thickness and the GCC thickness and between Raynaud's phenomenon duration and the average RNFL and GCC thickness (p < 0.05). NFC and LDI measurements did not show correlations with OCT parameters. CONCLUSION A thinner temporal RNFL and the correlation between Raynaud's phenomenon and disease duration and structural abnormalities on OCT suggest the presence of early ganglion cell damage in patients with SSc. Although mild, these findings indicate the need to monitor ocular abnormalities in SSc.
Collapse
Affiliation(s)
- Cecilia Victoria Agapito Tito
- Rheumatology Division, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), Rua Botucatu 740, 3° andar, São Paulo, SP, 04023-062, Brazil
| | - Juliana Silvatti
- Rheumatology Division, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), Rua Botucatu 740, 3° andar, São Paulo, SP, 04023-062, Brazil
| | - Izabela N F de Almeida
- Department of Ophthalmology and Visual Science, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Elise V Taniguchi
- Department of Ophthalmology and Visual Science, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Tiago S Prata
- Department of Ophthalmology and Visual Science, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Augusto Paranhos
- Department of Ophthalmology and Visual Science, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Cristiane Kayser
- Rheumatology Division, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), Rua Botucatu 740, 3° andar, São Paulo, SP, 04023-062, Brazil.
| |
Collapse
|
10
|
Melillo GHDL, Scoralick ALB, Kanadani FN, Gracitelli CPB, Paranhos A, Prata TS. Long-term intraocular pressure fluctuation in patients with stable glaucoma: the impact of regression to the mean on glaucoma management. Arq Bras Oftalmol 2021; 84:519-520. [PMID: 34550223 DOI: 10.5935/0004-2749.202100116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 06/15/2021] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Ana Luiza Bassoli Scoralick
- Department of Ophthalmology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Fábio Nishimura Kanadani
- Department of Glaucoma, Instituto de Olhos Ciências Médicas, Belo Horizonte, MG, Brazil.,Department of Ophthalmology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil.,Department of Ophthalmology, Mayo Clinic, Jacksonville, FL, USA
| | - Carolina Pelegrini Barbosa Gracitelli
- Department of Ophthalmology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil.,Centro de Estudos Alcides Hirai, Ver Mais Oftalmologia, Vinhedo, São Paulo, SP, Brazil
| | - Augusto Paranhos
- Department of Ophthalmology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Tiago S Prata
- Department of Ophthalmology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil.,Department of Ophthalmology, Mayo Clinic, Jacksonville, FL, USA
| |
Collapse
|
11
|
Fares NT, Portela RC, Machado LF, Polizelli M, Freitas DD, Paranhos A, Prata TS, Gracitelli CPB. Effect of steroid eyedrops after trabeculectomy in glaucoma patients: a keratograph analysis. Arq Bras Oftalmol 2021; 84:345-351. [PMID: 33567039 DOI: 10.5935/0004-2749.20210050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 04/28/2020] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To investigate the use of preoperative steroid eyedrops in glaucoma patients undergoing trabeculectomy for ocular surface disease. METHODS A total of 31 eyes of 31 glaucoma patients were included. Only glaucoma patients who had been using at least three topical intraocular pressure-lowering medications for longer than 6 months were included. All patients were treated with loteprednol etabonate ophthalmic suspension 0.5% four times per day for 1 week before trabeculectomy. Data from baseline (day of surgery) and the follow-up visit (2 weeks after surgery) were included. All patients underwent a detailed ophthalmologic examination. Ocular surface disease was evaluated using the Ocular Surface Disease Index questionnaire and clinical measures, including tear breakup time, conjunctival hyperemia, and biomicroscopy to detect the presence or absence of keratitis. Ocular Surface Disease Index scores greater than 13 indicated a clinically relevant presence of ocular surface disease. In addition, all patients underwent keratograph analysis. The comparison of ocular surface disease before and after trabeculectomy was assessed using a paired test. RESULTS The mean age of the glaucoma patients was 69.90 ± 10.77 years. The average visual acuity was 0.40 ± 0.34 logMAR. The overall Ocular Surface Disease Index prevalence rate was 27.20 ± 17.56 units. Clinical assessment revealed no significant difference in bulbar redness, breakup time, or keratitis before and after surgery (p>0.05 for all comparisons). Keratograph analysis showed that the only two parameters that were significantly different before and after trabeculectomy ewere the bulbar redness by keratograph (BR-K) and the average noninvasive tear breakup time. Patients presented more conjunctival hyperemia and shorter noninvasive tear breakup time after trabeculectomy as compared with before surgery (p=0.013 and p=0.041, respectively). CONCLUSIONS The present study not only confirms the high prevalence of clinical findings of ocular surface disease in glaucoma patients but also reveals new objective parameters measured by keratograph analysis. Apart from using loteprednol etabonate ophthalmic suspension 0.5% 1 week before the surgery, our sample presented a worsening of conjunctival hyperemia (bulbar redness by keratograph) and also a shorter noninvasive tear breakup time postoperatively.
Collapse
Affiliation(s)
- Nikoly T Fares
- Department of Ophthalmology and Visual Science, Glaucoma Service, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Renata C Portela
- Department of Ophthalmology and Visual Science, Glaucoma Service, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Lilian F Machado
- Department of Ophthalmology and Visual Science, Glaucoma Service, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Murilo Polizelli
- Department of Ophthalmology and Visual Science, Glaucoma Service, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Denise de Freitas
- Department of Ophthalmology and Visual Science, Glaucoma Service, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Augusto Paranhos
- Department of Ophthalmology and Visual Science, Glaucoma Service, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Tiago S Prata
- Department of Ophthalmology and Visual Science, Glaucoma Service, Universidade Federal de São Paulo, São Paulo, Brazil.,Glaucoma Unit, Hospital Medicina dos Olhos, Osasco, SP, Brazil.,Department of Ophthalmology, Mayo Clinic, Jacksonville, FL, USA.,Department of Ophthalmology, Glaucoma Service, Hospital Oftalmológico de Sorocaba, Sorocaba, SP, Brazil
| | - Carolina P B Gracitelli
- Department of Ophthalmology and Visual Science, Glaucoma Service, Universidade Federal de São Paulo, São Paulo, Brazil.,Glaucoma Unit, Ver Mais Oftalmologia, Vinhedo, SP, Brazil
| |
Collapse
|
12
|
Lourenço AS, Araújo CCQD, Santos PMD, Prata TS, Lopes NLV, Santos RCRD, Gracitelli CPB, Faria NVLD. Assessment of short-term intraocular pressure parameters in phakic and pseudophakic patients with primary open-angle glaucoma. Arq Bras Oftalmol 2021; 84:425-429. [PMID: 34320100 DOI: 10.5935/0004-2749.20210066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 06/09/2020] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To investigate intraocular pressure peaks in phakic and pseudophakic patients with primary open-angle glaucoma. METHOD Overall, 40 patients with primary open-angle glaucoma were assessed. Of these, 20 patients were phakic and 20 pseudophakic. One eye (randomly selected) was included in the study. All patients underwent the intraocular pressure curves test, followed by the water-drinking test. RESULTS A statistically significant difference was observed between the phakic and pseudophakic patients regarding the mean of the peaks in the intraocular pressure curves (p=0.045). A statistically significant intergroup difference was noted regarding the intraocular pressure peaks in the water-drinking test, with higher values observed in the phakic patients (p 0.004). CONCLUSION The intraocular pressure peaks in the water-drinking test and intraocular pressure curves were higher in the phakic group than in the pseudophakic group.
Collapse
Affiliation(s)
| | | | | | - Tiago S Prata
- Department of Ophthalmology and Visual Science, Universidade Federal de São Paulo, São Paulo, SP, Brazil.,Ophthalmology, Mayo Clinic, Jacksonville, United States.,Ophthalmology, Hospital Medicina dos Olhos, Osasco, SP, Brazil
| | - Nara Lidia Vieira Lopes
- Department of Ophthalmology and Visual Science, Universidade Federal de São Paulo, São Paulo, SP, Brazil.,Centro Brasileiro da Visão, Brasilia, DF, Brazil
| | | | - Carolina P B Gracitelli
- Department of Ophthalmology and Visual Science, Universidade Federal de São Paulo, São Paulo, SP, Brazil.,Ver Mais Oftalmologia, Vinhedo, São Paulo, SP, Brazil.,Vera Cruz Oftalmologia, Campinas, São Paulo, SP, Brazil
| | - Nubia Vanessa Lima de Faria
- Department of Ophthalmology and Visual Science, Universidade Federal de São Paulo, São Paulo, SP, Brazil.,Centro Brasileiro da Visão, Brasilia, DF, Brazil
| |
Collapse
|
13
|
Daga FB, Almeida I, Prata TS, Paranhos A. Marijuana for glaucoma treatment: a recipe for disaster. Arq Bras Oftalmol 2021; 84:V-VII. [PMID: 33787664 DOI: 10.5935/0004-2749.20210056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 07/27/2020] [Indexed: 11/20/2022] Open
Affiliation(s)
- Fábio B Daga
- Brazilian Glaucoma Society.,Department of Ophthalmology, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Izabela Almeida
- Brazilian Glaucoma Society.,Department of Ophthalmology, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Tiago S Prata
- Brazilian Glaucoma Society.,Department of Ophthalmology, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Augusto Paranhos
- Brazilian Glaucoma Society.,Department of Ophthalmology, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| |
Collapse
|
14
|
Ikeda MC, Hamada KU, Bando AH, Nakamura VPL, Prata TS, Tatham AJ, Paranhos A, Gracitelli CPB. Interventions to Improve Reading Performance in Glaucoma. Ophthalmol Glaucoma 2021; 4:624-631. [PMID: 33813064 DOI: 10.1016/j.ogla.2021.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 03/24/2021] [Accepted: 03/26/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE To evaluate whether changes to contrast, line spacing, or font size can improve reading performance in patients with glaucoma. DESIGN Cross-sectional study. PARTICIPANTS Thirty-five patients with glaucoma and 32 healthy control participants. METHODS A comprehensive ophthalmologic examination was performed followed by reading speed assessment using the Minnesota Low Vision Reading (MNREAD) test under a range of contrasts (10%, 20%, 30%, 40%, and 50%), line spacings (1.0, 1.5, 2.0, 2.5, and 3.0 lines), and font sizes (0.8, 0.9, 1.0, 1.1, and 1.2 logarithm of the minimum angle of resolution), for a total of 15 tests. Regression analyses were performed to examine the effect of varying test conditions on reading speed (measured in words per minute [wpm]). RESULTS Participants' mean age was 63.0 ± 12.6 years. Patients with glaucoma showed a visual field mean deviation in the better eye of -6.29 ± 6.35 dB. Reading speeds were significantly slower in patients with glaucoma versus control participants for 14 of the 15 MNREAD tests, despite no significant differences in age, gender, or education between groups. Increased contrast (from 10% to 50%) was associated with faster reading speed in patients with glaucoma (10.6-wpm increase per 10% increase in contrast; 95% confidence interval, 7.4-13.8 wpm; P < 0.001; R2 = 0.211). No significant improvement was found in reading speed with increase in font size or line spacing. CONCLUSIONS Patients with glaucoma showed significantly slower reading speeds than similarly aged control participants. Reading speed was improved by increasing contrast, but not by increases in line spacing or font size.
Collapse
Affiliation(s)
- Mariana C Ikeda
- Department of Ophthalmology and Visual Science, Glaucoma Service, Federal University of São Paulo, São Paulo, Brazil
| | - Koiti U Hamada
- Department of Ophthalmology and Visual Science, Glaucoma Service, Federal University of São Paulo, São Paulo, Brazil
| | - Andre H Bando
- Department of Ophthalmology and Visual Science, Glaucoma Service, Federal University of São Paulo, São Paulo, Brazil
| | - Vinicius P L Nakamura
- Department of Ophthalmology and Visual Science, Glaucoma Service, Federal University of São Paulo, São Paulo, Brazil
| | - Tiago S Prata
- Department of Ophthalmology and Visual Science, Glaucoma Service, Federal University of São Paulo, São Paulo, Brazil; Glaucoma Unit, Hospital Medicina dos Olhos, Osasco, Brazil; Department of Ophthalmology, Mayo Clinic, Jacksonville, Florida; Department of Ophthalmology, Glaucoma Service, Hospital Oftalmológico de Sorocaba-BOS, Sorocaba, Brazil
| | - Andrew J Tatham
- Princess Alexandra Eye Pavilion and Department of Ophthalmology, University of Edinburgh, Edinburgh, United Kingdom
| | - Augusto Paranhos
- Department of Ophthalmology and Visual Science, Glaucoma Service, Federal University of São Paulo, São Paulo, Brazil
| | - Carolina P B Gracitelli
- Department of Ophthalmology and Visual Science, Glaucoma Service, Federal University of São Paulo, São Paulo, Brazil; Centro de Estudos Alcides Hirai, Ver Mais Oftalmologia, Vinhedo, São Paulo, Brazil.
| |
Collapse
|
15
|
Nazareth T, Rocha J, Scoralick ALB, Dias DT, Gracitelli CPB, Kanadani FN, Prata TS. <p>Retinal Sensitivity Thresholds Obtained Through Easyfield and Humphrey Perimeters in Eyes with Glaucoma: A Cross-Sectional Comparative Study</p>. Clin Ophthalmol 2020; 14:4201-4207. [PMID: 33299296 PMCID: PMC7719433 DOI: 10.2147/opth.s280692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 11/10/2020] [Indexed: 11/24/2022] Open
Abstract
Objective To compare global retinal sensitivity thresholds obtained through the Easyfield perimeter (EF) and Humphrey visual field analyzer (HFA). Design Observational cross-sectional study. Participants Glaucomatous patients and glaucoma suspects enrolled between October 2018 and April 2019. Materials and Methods All participants underwent EF (SPARK Precision) and HFA perimetry (SITA-Standard). After inclusion, demographic and ocular data were collected, including measurements of retinal nerve fiber layer (RNFL) thickness obtained from spectral-domain optical coherence tomography (SD-OCT). Global indices (mean deviation, MD; pattern standard deviation, PSD) values were compared between perimeters, and their correlation and agreement were evaluated. We used regression analysis to investigate structure-functional correlations between SD-OCT measurements and MD index of each perimeter. Results We investigated 111 eyes from 69 patients. Mean MD (mean difference=1.49dB) and PSD values (mean difference=0.42dB) from the HFA were significantly larger than those from the EF perimeter (p<0.001). There were significant linear correlations between EF-MD and HFA-MD (r=0.56), and EF-PSD and HFA-PSD (r=0.38; p<0.001). We found significant non-linear associations between average RNFL thickness and MD values derived from both EF (R2=0.41) and HFA (R2=0.17) perimeters (p≤0.012). A difference <2dB between EF-MD and HFA-MD was found in 53% of the eyes, while 71% of them had a difference <1dB between EF-PSD and HFA-PSD. Conclusion While we found a moderate correlation and a small mean sensitivity difference between test results, EF’s correlation with structural measurements was at least comparable to that of the HFA. Our findings suggest that although these tests should not be used interchangeably, EF SPARK Precision could be used as an alternative for functional assessment in eyes with mild glaucoma.
Collapse
Affiliation(s)
- Thaissa Nazareth
- Glaucoma Service, Instituto de Olhos Ciências Médicas, Belo Horizonte, Brazil
| | - Janaina Rocha
- Glaucoma Service, Instituto de Olhos Ciências Médicas, Belo Horizonte, Brazil
- Ophthalmology Department, Federal University of São Paulo, São Paulo, Brazil
| | | | - Diego T Dias
- Ophthalmology Department, Federal University of São Paulo, São Paulo, Brazil
| | | | - Fabio N Kanadani
- Glaucoma Service, Instituto de Olhos Ciências Médicas, Belo Horizonte, Brazil
- Ophthalmology Department, Mayo Clinic, Jacksonville, Florida, USA
| | - Tiago S Prata
- Ophthalmology Department, Federal University of São Paulo, São Paulo, Brazil
- Ophthalmology Department, Mayo Clinic, Jacksonville, Florida, USA
- Correspondence: Tiago S Prata Ophthalmology Department, Federal University of São Paulo, Rua Dr João Lourenço, 713; Vila Nova Conceição, São PauloCEP: 04508-031, BrazilTel +55 11 43019481Fax +55 11 3683-0404 Email
| |
Collapse
|
16
|
Almeida I, Scoralick ALB, Dias DT, Ushida M, Dorairaj S, Gracitelli CP, Paranhos A, Kanadani FN, Prata TS. Comparison between provocative test-based and long-term intraocular pressure parameters in patients with stable open-angle glaucoma. Eur J Ophthalmol 2020; 31:453-459. [PMID: 32162542 DOI: 10.1177/1120672120911337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To compare provocative test-based and long-term intraocular pressure variation parameters in patients with stable open-angle glaucoma. METHODS A prospective observational study was carried out in which stable open-angle glaucoma patients (⩾3 years of follow-up without any changes on current medical regimen) were consecutively enrolled. All patients were submitted to a water-drinking test. Long-term intraocular pressure parameters were obtained from isolated intraocular pressure measurements from each visit (⩾5 visits). We investigated the correlation and agreement between the following water-drinking test and long-term intraocular pressure parameters: mean, peak, and fluctuation. In addition, the percentage of eyes with significant intraocular pressure peaks during the water-drinking test (defined as a difference ⩾25% between water-drinking test intraocular pressure peak and mean long-term intraocular pressure) was assessed. RESULTS Sixty-three eyes from 63 open-angle glaucoma patients (mean age, 60.7 ± 11.8 years) were included. Mean and water-drinking test intraocular pressure peak correlated significantly with mean (r = 0.67) and maximum long-term intraocular pressure (r = 0.52), respectively (p < 0.01). The correlation between water-drinking test intraocular pressure fluctuation and long-term intraocular pressure fluctuation was not significant (p = 0.45). Limits of agreement from Bland-Altman plots exceeded the maximum allowed difference between methods (3 mm Hg) for all the intraocular pressure parameters analyzed, suggesting poor agreement between water-drinking test-derived and long-term intraocular pressure values. Overall, significant water-drinking test intraocular pressure peaks were observed in 39.7% of these eyes with stable open-angle glaucoma. CONCLUSION Although some water-drinking test-based and long-term intraocular pressure parameters correlate significantly, water-drinking test results may not reflect the long-term intraocular pressure profile of stable open-angle glaucoma patients, as their agreement is poor. Many of these patients may experience significant water-drinking test intraocular pressure peaks, despite long-standing stable disease and unchanged medical regimen.
Collapse
Affiliation(s)
- Izabela Almeida
- Glaucoma Service, Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil.,Glaucoma Unit, Hospital Medicina dos Olhos, Osasco, Brazil
| | - Ana Luiza B Scoralick
- Glaucoma Service, Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil.,Glaucoma Unit, Hospital Medicina dos Olhos, Osasco, Brazil
| | - Diego T Dias
- Glaucoma Service, Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil.,Glaucoma Unit, Hospital Medicina dos Olhos, Osasco, Brazil
| | - Michele Ushida
- Glaucoma Unit, Hospital Medicina dos Olhos, Osasco, Brazil
| | - Syril Dorairaj
- Department of Ophthalmology, College of Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Carolina Pb Gracitelli
- Glaucoma Service, Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil
| | - Augusto Paranhos
- Glaucoma Service, Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil
| | - Fábio N Kanadani
- Department of Ophthalmology, College of Medicine, Mayo Clinic, Jacksonville, FL, USA.,Department of Ophthalmology, Instituto de Olhos Ciências Médicas, Belo Horizonte, Brazil
| | - Tiago S Prata
- Glaucoma Service, Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil.,Glaucoma Unit, Hospital Medicina dos Olhos, Osasco, Brazil.,Department of Ophthalmology, College of Medicine, Mayo Clinic, Jacksonville, FL, USA
| |
Collapse
|
17
|
Guimarães MEV, de Pádua Soares Bezerra B, de Miranda Cordeiro F, Carvalho CHS, Danif DN, Prata TS, Dorairaj SK, Kanadani FN. Glaucoma Surgery with Soaked Sponges with Mitomycin C vs Sub-Tenon Injection: Short-term Outcomes. J Curr Glaucoma Pract 2019; 13:50-54. [PMID: 31564793 PMCID: PMC6743312 DOI: 10.5005/jp-journals-10078-1254] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
AIM The aim of this study is to compare the outcomes, success rates, complications, and number of interventions of the trabeculectomy surgery with mitomycin C (MMC) in two different techniques: conventional soaked sponges and sub-Tenon injection. MATERIALS AND METHODS An observational retrospective study was performed with 79 eyes of 64 participants who underwent a glaucoma surgery with MMC. The conventional sponge soaked with MMC 0.03% for 3 minutes over the scleral flap (group I) and the subtenon injection of 0.1 mL of MMC 0.03% (group II) techniques were used to deliver the MMC. The data collected were patient demographics, preoperative intraocular pressure (IOP), central corneal thickness (CCT), number of pre- and postoperative ocular hypotensive drugs, postoperative complications, number of interventions, and need of further glaucoma surgery. RESULTS Seventy-nine eyes were divided into two: 39 eyes (49.37%) in group I and 40 eyes (50.63%) in group II. Trabeculectomy was performed in 53.17% and phacotrabeculectomy in 46.83%. The IOP decreased from 18.0 ± 11.0 mm Hg at the baseline to 10.0 ± 3.0 mm Hg at the last visit in group I and, in group II, from 16.0 ± 10.0-13.0 ± 6.0 mm Hg (median ± ID), p < 0.001. There were no significant differences between the groups regarding demographics, median follow-up, IOP in baseline, CCT, drugs reduction, success criteria adopted, postsurgical interventions, surgical complications, and need for new procedures (p > 0.05). CONCLUSION Sub-Tenon injection of MMC is a safe and as effective as the conventional soaked sponge method in trabeculectomies. This method reduces surgical time and sponge-related risks with equivalent surgical efficacy. CLINICAL SIGNIFICANCE As trabeculectomy is still the most common surgical procedure to reduce IOP and scar formation is one of the main causes of surgical failure, it is important to develop surgical techniques to improve its outcomes. HOW TO CITE THIS ARTICLE Guimarães MEV, de Pádua Soares Bezerra B, et al. Glaucoma Surgery with Soaked Sponges with Mitomycin C vs Sub-Tenon Injection: Short-term Outcomes. J Curr Glaucoma Pract 2019;13(2):50-54.
Collapse
Affiliation(s)
- Maria EV Guimarães
- Department of Ophthalmology, Instituto de Olhos Ciências Médicas, Belo Horizonte, Minas Gerais, Brazil
| | - Bernardo de Pádua Soares Bezerra
- Department of Ophthalmology, Instituto de Olhos Ciências Médicas, Belo Horizonte, Minas Gerais, Brazil; Royal Victorian Eye and Ear Hospital, Melbourne, Australia
| | | | - Christiano HS Carvalho
- Department of Ophthalmology, Instituto de Olhos Ciências Médicas, Belo Horizonte, Minas Gerais, Brazil
| | - Daniella N Danif
- Department of Ophthalmology, Instituto de Olhos Ciências Médicas, Belo Horizonte, Minas Gerais, Brazil
| | - Tiago S Prata
- Department of Ophthalmology, Mayo Clinic, Jacksonville, Florida, USA; Department of Ophthalmology and Visual Science, Federal University of São Paulo, São Paulo, Brazil; Glaucoma Unit, Hospital Medicina dos Olhos, Osasco, São Paulo, Brazil; Department of Ophthalmology, Glaucoma Service, Hospital Oftalmológico de Sorocaba—BOS, Sorocaba, São Paulo, Brazil
| | - Syril K Dorairaj
- Department of Ophthalmology, Mayo Clinic, Jacksonville, Florida, USA
| | - Fábio N Kanadani
- Department of Ophthalmology, Instituto de Olhos Ciências Médicas, Belo Horizonte, Minas Gerais, Brazil; Department of Ophthalmology, Mayo Clinic, Jacksonville, Florida, USA
| |
Collapse
|
18
|
Lopes FS, Matsubara I, Almeida I, Dorairaj SK, Vessani RM, Paranhos A, Prata TS. Structure-function relationships in glaucoma using enhanced depth imaging optical coherence tomography-derived parameters: a cross-sectional observational study. BMC Ophthalmol 2019; 19:52. [PMID: 30770751 PMCID: PMC6377769 DOI: 10.1186/s12886-019-1054-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Accepted: 01/29/2019] [Indexed: 12/14/2022] Open
Abstract
Background To investigate structural and functional correlations in glaucoma patients using enhanced depth imaging spectral-domain optical coherence tomography (EDI OCT)-derived parameters. Methods We prospectively enrolled healthy participants and glaucomatous patients with a wide range of disease stages. All participants underwent visual field (VF) testing (SITA - Standard 24–2; Carl Zeiss Meditec, Dublin, CA) and EDI OCT imaging (Spectralis; Heidelberg Engineering Co., Heidelberg, Germany). The following optic nerve head parameters were measured on serial vertical EDI OCT B-scans by two experienced examiners masked to patients clinical data: lamina cribrosa (LC) thickness and area, prelaminar neural tissue thickness and area, anterior LC depth, Bruch’s membrane opening (BMO) and average, superior, and inferior BMO-minimum rim width (BMO-MRW). Only good quality images were considered, and whenever both eyes were eligible, one was randomly selected for analysis. Scatter plots were constructed to investigate correlations between each anatomic parameter and patient’s VF status (based on VF index [VFI] values). Results A total of 73 eyes of 73 patients were included. All EDI OCT parameters evaluated differed significantly between glaucomatous and control eyes (P ≤ 0.045). A secondary analysis, in which glaucomatous patients were divided according to VF mean deviation index values into 3 groups (mild [G1; > − 6 dB], moderate [G2; − 6 to − 12 dB] and advanced [G3; <− 12 dB] glaucoma), revealed that average BMO-MRW was the EDI OCT parameter that presented more significant differences between the different stages of glaucoma. Significant structure-function correlations were found between VFI values and prelaminar neural tissue area (R2 = 0.20, P = 0.017), average BMO-MRW (R2 = 0.35, P ≤ 0.001), superior BMO-MRW (R2 = 0.21, P = 0.012), and inferior BMO-MRW (R2 = 0.27, P = 0.002). No significant correlations were found for LC area and anterior LC depth (P ≥ 0.452). Conclusions Evaluating the distribution pattern and structure-function correlations of different laminar and prelaminar EDI OCT-derived parameters in glaucomatous patients, we found better results for neural tissue-based indexes (compared to LC-derived parameters). The diagnostic utility of each parameter deserves further investigations. Electronic supplementary material The online version of this article (10.1186/s12886-019-1054-9) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Flavio S Lopes
- Glaucoma Service, Department of Ophthalmology, Federal University of São Paulo, Rua Botucatu, 821, Vila Clementino, São Paulo, 04021-001, Brazil.,Glaucoma Unit, Hospital Medicina dos Olhos, R. Salém Bechara, 281, Centro, Osasco, 06018-180, Brazil
| | - Igor Matsubara
- Glaucoma Service, Department of Ophthalmology, Federal University of São Paulo, Rua Botucatu, 821, Vila Clementino, São Paulo, 04021-001, Brazil.,Glaucoma Unit, Hospital Medicina dos Olhos, R. Salém Bechara, 281, Centro, Osasco, 06018-180, Brazil
| | - Izabela Almeida
- Glaucoma Service, Department of Ophthalmology, Federal University of São Paulo, Rua Botucatu, 821, Vila Clementino, São Paulo, 04021-001, Brazil.,Glaucoma Unit, Hospital Medicina dos Olhos, R. Salém Bechara, 281, Centro, Osasco, 06018-180, Brazil
| | - Syril K Dorairaj
- Department of Ophthalmology, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL, 32224, USA.
| | - Roberto M Vessani
- Glaucoma Service, Department of Ophthalmology, Federal University of São Paulo, Rua Botucatu, 821, Vila Clementino, São Paulo, 04021-001, Brazil
| | - Augusto Paranhos
- Glaucoma Service, Department of Ophthalmology, Federal University of São Paulo, Rua Botucatu, 821, Vila Clementino, São Paulo, 04021-001, Brazil
| | - Tiago S Prata
- Glaucoma Service, Department of Ophthalmology, Federal University of São Paulo, Rua Botucatu, 821, Vila Clementino, São Paulo, 04021-001, Brazil.,Glaucoma Unit, Hospital Medicina dos Olhos, R. Salém Bechara, 281, Centro, Osasco, 06018-180, Brazil.,Department of Ophthalmology, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL, 32224, USA
| |
Collapse
|
19
|
Machado LF, Kawamuro M, Portela RC, Fares NT, Bergamo V, Souza LMD, Paranhos Júnior A, Prata TS, Gracitelli CPB. Factors associated with vision-related quality of life in Brazilian patients with
glaucoma. Arq Bras Oftalmol 2019; 82:463-470. [DOI: 10.5935/0004-2749.20190089] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 01/29/2019] [Indexed: 11/20/2022] Open
|
20
|
Scoralick ALB, Gracitelli CP, Dias DT, Almeida I, Ushida M, Dorairaj S, Kanadani FN, Paranhos A, Prata TS. Peak, Fluctuation, or Mean? A Correlation Analysis of Long-term Intraocular Pressure Variation Parameters in Patients with Stable Glaucoma. J Curr Glaucoma Pract 2019; 13:28-31. [PMID: 31496558 PMCID: PMC6710932 DOI: 10.5005/jp-journals-10078-1240] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Aim To perform a correlation analysis between long-term intraocular pressure (IOP) variation parameters (mean, peak, and fluctuation) in patients with stable open-angle glaucoma (OAG). Materials and methods A cross-sectional observational study was carried out, in which patients with stable OAG were consecutively enrolled. All patients had to have glaucomatous optic neuropathy and characteristic visual field (VF) defects. Key inclusion criteria were ≥5 VF tests, ≥3 disc photographs, and ≥3 years of follow-up without any changes in current medical regimen. Stable OAG was defined as nonprogressive VF results and absence of anatomical changes for at least 3 years. Long-term IOP variation parameters were obtained from isolated IOP measurements from each visit (minimum of five IOP measurements). The main outcome measure was the correlation between these IOP variation parameters. Results Of the 63 patients studied, 37 (59%) were women, and the mean age was 61 ± 12 years. Among all the analyses, IOP mean and peak had the strongest correlation (r = 0.94; 95% CI = 0.92–0.97; p < 0.001). There were also significant correlations between IOP peak and IOP fluctuation (r = 0.84; 95% CI = 0.75–0.90; p < 0.001), and mean IOP and IOP fluctuation (r = 0.62; 95% CI = 0.43–0.75; p < 0.001). Conclusion Most long-term IOP variation parameters evaluated seem to be highly correlated. Notably, the correlation between mean IOP and IOP peak was the strongest one. We believe this fact should be taken into consideration as their inclusion as individual variables in a multiple regression model could lead to misinterpretation of the data. Clinical significance Different well-designed studies are conflicting regarding which long-term IOP variation parameter is more clinically relevant. Our findings suggest that collinearity issues could explain in part the discrepant results among these studies evaluating the relationship between long-term IOP variation parameters and glaucoma prognosis. How to cite this article Scoralick ALB, Gracitelli CPB, et al. Peak, Fluctuation, or Mean? A Correlation Analysis of Long-term Intraocular Pressure Variation Parameters in Patients with Stable Glaucoma. J Curr Glaucoma Pract 2019;13(1):28–31.
Collapse
Affiliation(s)
- Ana Luiza B Scoralick
- Glaucoma Service, Department of Ophthalmology and Visual Science, Federal University of São Paulo, São Paulo, Brazil; Glaucoma Unit, Hospital Medicina dos Olhos, Osasco, Brazil; Department of Ophthalmology, Instituto de Olhos Ciências Médicas, Belo Horizonte, Brazil
| | - Carolina Pb Gracitelli
- Glaucoma Service, Department of Ophthalmology and Visual Science, Federal University of São Paulo, São Paulo, Brazil
| | - Diego T Dias
- Glaucoma Service, Department of Ophthalmology and Visual Science, Federal University of São Paulo, São Paulo, Brazil; Glaucoma Unit, Hospital Medicina dos Olhos, Osasco, Brazil
| | - Izabela Almeida
- Glaucoma Service, Department of Ophthalmology and Visual Science, Federal University of São Paulo, São Paulo, Brazil; Glaucoma Unit, Hospital Medicina dos Olhos, Osasco, Brazil
| | - Michele Ushida
- Glaucoma Unit, Hospital Medicina dos Olhos, Osasco, Brazil
| | - Syril Dorairaj
- Department of Ophthalmology, Mayo Clinic, Jacksonville, Florida, USA
| | - Fábio N Kanadani
- Glaucoma Service, Department of Ophthalmology and Visual Science, Federal University of São Paulo, São Paulo, Brazil
| | - Augusto Paranhos
- Department of Ophthalmology, Instituto de Olhos Ciências Médicas, Belo Horizonte, Brazil
| | - Tiago S Prata
- Glaucoma Service, Department of Ophthalmology and Visual Science, Federal University of São Paulo, São Paulo, Brazil; Glaucoma Unit, Hospital Medicina dos Olhos, Osasco, Brazil; Department of Ophthalmology, Mayo Clinic, Jacksonville, Florida, USA
| |
Collapse
|
21
|
Daher F, Almeida I, Ushida M, Soares B, Dorairaj S, Kanadani FN, Paranhos A, Gracitelli CPB, Prata TS. Intraocular Pressure Spikes within First Postoperative Hours following Standard Trabeculectomy: Incidence and Associated Factors. Ophthalmic Res 2017; 59:142-147. [PMID: 29069653 DOI: 10.1159/000480736] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 08/28/2017] [Indexed: 11/19/2022]
Abstract
PURPOSE To evaluate the incidence of intraocular pressure (IOP) spikes within the first postoperative hours following trabeculectomy (TRAB) and to determine possible associated factors. METHODS An observational study was carried out. We enrolled consecutive patients undergoing standard TRAB with mitomycin C. They were examined twice within the first few postoperative hours (hours 1-2 and 4-6) and 3 times after TRAB (on days 1, 7, and 30). Demographic and ocular data were collected. Main outcome measurements were postoperative IOP values at each time point and the frequency of IOP spikes, defined as IOP ≥25 mm Hg. RESULTS A total of 40 eyes of 40 patients were included (mean age 59.62 ± 13.37 years). Although IOP was significantly reduced to 11.14 ± 7.99 mm Hg at hours 1-2 (p < 0.01) and to 11.52 ± 7.30 mm Hg at hours 4-6 (p < 0.01), IOP spikes were documented in 3 patients (7.5%). In the group of patients with IOP spikes, we noted that there was a high incidence of black patients and that the surgeries had been performed by fellow surgeons. CONCLUSION Although the majority of the cases (92.5% of the patients) did not present IOP spikes, 7.5% of our patients presented the event. In selected cases, such as those with advanced disease, fixation threat, and of black race, IOP should be monitored during the first few postoperative hours for the identification and adequate management of potential IOP spikes, preventing undesirable outcomes.
Collapse
Affiliation(s)
- Felipe Daher
- Department of Ophthalmology and Visual Sciences, Glaucoma Service, Federal University of São Paulo, São Paulo, Brazil
| | | | | | | | | | | | | | | | | |
Collapse
|
22
|
B Scoralick AL, Almeida I, Ushida M, T Dias D, Dorairaj S, S Prata T, N Kanadani F. Hypotony Management through Transconjunctival Scleral Flap Resuturing: Analysis of Surgical Outcomes and Success Predictors. J Curr Glaucoma Pract 2017; 11:58-62. [PMID: 28924340 PMCID: PMC5577121 DOI: 10.5005/jp-journals-10028-1224] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 03/02/2017] [Indexed: 11/25/2022] Open
Abstract
Aim To investigate surgical outcomes and success predictors of transconjunctival scleral flap resuturing for the management of hypotony due to overfiltration following trabeculectomy with mitomycin C. Materials and methods Noncomparative, retrospective, interventional case series in which all glaucoma patients from two glaucoma services undergoing transconjunctival scleral flap resuturing between May 2012 and July 2016 were enrolled. Included eyes had to have hypotony [intraocular pressure (IOP) < 6 mm Hg] and/or hypotony maculopathy caused by excessive filtration following trabeculectomy. Key exclusion criteria were wound/bleb leaking and postoperative ocular trauma or infection. Preoperative and postoperative IOP, best-corrected visual acuity (BCVA), fundus imaging, surgical complications, and any subsequent related events or procedures were recorded. Rates of postsurgical hypotony and/or maculopathy resolution and possible success predictors were investigated. Results A total of 22 patients (22 eyes) with a mean age of 56.4 ± 15.2 years were included. Median follow-up was 245 days [interquartilerange (IR); 120-817 days] and mean IOP was increased from 2.9 ± 1.5 mm Hg (1-6 mm Hg) to 8.5 ± 3.1 mm Hg (2-16 mm Hg) at the last follow-up visit (p < 0.01). Approximately 75% of the cases (16 out of 22) had an IOP between 7 and 18 mm Hg at the end of the follow-up period. Median BCVA (log MAR) at last follow-up visit [0.1 (IR; 0.0- 0.3)] was significantly better than preoperative BCVA [0.4 (IR; 0.11.0); p < 0.01]. Hypotony resolved in 81% of the cases, while maculopathy resolution was found in 85% of the cases. Time interval between trabeculectomy and flap resuturing was the only factor significantly associated with patient’s IOP at last follow-up visit (R2 = 0.23; p = 0.036). Success rates (IOP > 6 mm Hg at last follow-up visit) were halved in those left untreated for more than 6 months. No serious adverse event was recorded. Conclusion Our findings support the use of transconjunctival scleral flap resuturing as an effective and safe alternative for hypotony management due to overflitration following trabeculectomy. As time interval seems to influence the odds of hypotony resolution, early intervention is recommended. How to cite this article Scoralick ALB, Almeida I, Ushida M, Dias DT, Dorairaj S, Prata TS, Kanadani FN, Hypotony Management through Transconjunctival Scleral Flap Resuturing: Analysis of Surgical Outcomes and Success Predictors. J Curr Glaucoma Pract 2017;11(2):58-62.
Collapse
Affiliation(s)
- Ana Luiza B Scoralick
- Staff specialist, Department of Ophthalmology, Instituto de Olhos Ciencias Medicas, Belo Horizonte, Brazil
| | - Izabela Almeida
- Postgraduate Student, Department of Ophthalmology, Glaucoma Service, Federal University of Sao Paulo, Brazil; Glaucoma Unit Hospital Medicina dos Olhos, Osasco, Brazil
| | - Michele Ushida
- Staff specialist, Glaucoma Unit, Hospital Medicina dos Olhos, Osasco, Brazil
| | - Diego T Dias
- Postgraduate Student, Department of Ophthalmology, Glaucoma Service, Federal University of Sao Paulo, Brazil; Glaucoma Unit Hospital Medicina dos Olhos, Osasco, Brazil
| | - Syril Dorairaj
- Assistant Professor, Department of Ophthalmology, Mayo Clinic, Jacksonville Florida, USA
| | - Tiago S Prata
- Associate Professor, Department of Ophthalmology, Glaucoma Service, Federal University of Sao Paulo, Brazil; Glaucoma Unit Hospital Medicina dos Olhos, Osasco, Brazil; Department of Ophthalmology Glaucoma Service, Sorocaba Ophthalmology Hospital, BOS Sorocaba, Brazil
| | - Fábio N Kanadani
- Associate Professor, Department of Ophthalmology, Instituto de Olhos Ciencias Medicas, Belo Horizonte, Brazil
| |
Collapse
|
23
|
Prata TS, Lopes FS, Prado VG, Almeida I, Matsubara I, Dorairaj S, Furlanetto RL, Vessani RM, Paranhos A. In vivo analysis of glaucoma-related features within the optic nerve head using enhanced depth imaging optical coherence tomography. PLoS One 2017; 12:e0180128. [PMID: 28732047 PMCID: PMC5521739 DOI: 10.1371/journal.pone.0180128] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 06/10/2017] [Indexed: 12/04/2022] Open
Abstract
Structural differences between optic nerve head (ONH) parameters in glaucomatous and non-glaucomatous eyes has been documented, however the association between such parameters in patients with different disease stages is yet to be elucidated. We investigated the relationship between different laminar and prelaminar ONH structures using enhanced depth imaging spectral-domain optical coherence tomography (EDI OCT) in a population with and without glaucoma. In this observational case-control study, we prospectively enrolled healthy individuals and glaucomatous patients with different disease stages. All participants underwent EDI OCT imaging (Heidelberg Engineering). Following ONH parameters were measured on serial vertical B-scans by two examiners masked to patient’s clinical data: lamina cribrosa (LC) and prelaminar neural tissue (PLNT) thicknesses, Bruch’s membrane opening (BMO) and cup depth. Associations between cup depth, and laminar and prelaminar parameters were evaluated controlling for possible confounding factors such as axial length and disc size. Sixty-four eyes of 64 patients were included (30 with glaucoma and 34 controls). Eyes with glaucoma had significantly lower mean LC and PLNT thickness, and greater mean cup depth than controls (p<0.01). There was a significant negative association between PLNT thickness and cup depth in glaucomatous eyes (R2 = 0.158, p = 0.029). In addition, LC thickness correlated significantly with cup depth (R2 = 0.135, p = 0.045). Eyes with thinner LCs presented deeper cups. Overall, cup depth and BMO had the best and LC thickness had the worst intraobserver and interobserver reproducibility grading. In conclusion, significant associations were seen between cup depth, LC and PLNT thickness. Eyes with deeper cups not only had less neural tissue, but also thinner LCs, independent of disc size and axial length. Best reproducibility was found for prelaminar parameters compared to deeper ONH structures.
Collapse
Affiliation(s)
- Tiago S. Prata
- Glaucoma Service, Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil
- Glaucoma Unit, Hospital Medicina dos Olhos, Osasco, Brazil
| | - Flavio S. Lopes
- Glaucoma Service, Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil
- Glaucoma Unit, Hospital Medicina dos Olhos, Osasco, Brazil
| | - Vitor G. Prado
- Glaucoma Service, Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil
| | - Izabela Almeida
- Glaucoma Service, Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil
- Glaucoma Unit, Hospital Medicina dos Olhos, Osasco, Brazil
| | - Igor Matsubara
- Glaucoma Service, Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil
- Glaucoma Unit, Hospital Medicina dos Olhos, Osasco, Brazil
| | - Syril Dorairaj
- Department of Ophthalmology, Mayo Clinic, Jacksonville, United States of America
- * E-mail:
| | - Rafael L. Furlanetto
- Glaucoma Service, Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil
| | - Roberto M. Vessani
- Glaucoma Service, Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil
| | - Augusto Paranhos
- Glaucoma Service, Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil
| |
Collapse
|
24
|
Chun M, Gracitelli CPB, Lopes FS, Biteli LG, Ushida M, Prata TS. Selective laser trabeculoplasty for early glaucoma: analysis of success predictors and adjusted laser outcomes based on the untreated fellow eye. BMC Ophthalmol 2016; 16:206. [PMID: 27881155 PMCID: PMC5120519 DOI: 10.1186/s12886-016-0385-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 11/10/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To identify success predictors and to study the role of the fellow untreated eye as a co-variable for adjustment of intraocular pressure (IOP) outcomes following selective laser trabeculoplasty (SLT) in early open-angle glaucoma (OAG) patients. METHODS A case series was carried out. Patients with uncontrolled early OAG or ocular hypertension (inadequate IOP control requiring additional treatment) underwent SLT (one single laser session) performed by the same surgeon in a standardized fashion. The same preoperative medical regimen was maintained during follow-up for all patients. Post-treatment assessments were scheduled at week 1 and months 1, 2, and 3. In order to account for possible influence of IOP fluctuation on laser outcomes, post-laser IOP values of the treated eye of each patient were also analyzed adjusting for IOP changes (between visits variation) of the untreated fellow eye (adjusted analysis). Pre and post-laser IOP values were compared using paired t-test. Factors associated with the magnitude of IOP reduction were investigated using multiple regression analysis. RESULTS A total of 45 eyes of 45 patients were enrolled. Mean IOP was reduced from 20.8 ± 5.1 to 14.9 ± 2.9 mmHg at month 3 (p < 0.001). Adjusted success rate (defined as IOP reduction ≥ 20%) was 64% and mean percentage of IOP reduction was 23.1 ± 14.3% at last follow-up visit. Considering unadjusted post-laser IOP values, it was found a 20% greater absolute IOP reduction (median [interquartile range] 6 mmHg [4-7] vs 5 mmHg [3-7]; p = 0.04), with a success rate of 76%. Although baseline IOP was significantly associated with both adjusted and unadjusted post-laser IOP reduction, a stronger association was found when unadjusted IOP values were considered (p < 0.001 and R 2 = 0.35; p < 0.001 and R 2 = 0.67, respectively). Age, mean deviation (MD) index, central corneal thickness and type of glaucoma were not significant predictors (p ≥ 0.150). CONCLUSIONS In this group of patients with early OAG or ocular hypertension, our short-term results confirmed SLT as a safe and effective alternative for IOP reduction. Although better outcomes were found in eyes with higher preoperative IOP, this effect was mitigated when results were adjusted to the fellow untreated eye (to the influence of between visits-IOP fluctuations).
Collapse
Affiliation(s)
- Mikael Chun
- Department of Ophthalmology, Federal University of São Paulo, Rua Botucatu, 821. Vila Clementino, São Paulo, São Paulo, CEP: 04023-062, Brazil
| | - Carolina P B Gracitelli
- Department of Ophthalmology, Federal University of São Paulo, Rua Botucatu, 821. Vila Clementino, São Paulo, São Paulo, CEP: 04023-062, Brazil.
| | - Flavio S Lopes
- Department of Ophthalmology, Federal University of São Paulo, Rua Botucatu, 821. Vila Clementino, São Paulo, São Paulo, CEP: 04023-062, Brazil.,Glaucoma Unit, Hospital Medicina dos Olhos, Osasco, São Paulo, Brazil
| | - Luis G Biteli
- Department of Ophthalmology, Federal University of São Paulo, Rua Botucatu, 821. Vila Clementino, São Paulo, São Paulo, CEP: 04023-062, Brazil.,Glaucoma Unit, Hospital Medicina dos Olhos, Osasco, São Paulo, Brazil
| | - Michele Ushida
- Glaucoma Unit, Hospital Medicina dos Olhos, Osasco, São Paulo, Brazil
| | - Tiago S Prata
- Department of Ophthalmology, Federal University of São Paulo, Rua Botucatu, 821. Vila Clementino, São Paulo, São Paulo, CEP: 04023-062, Brazil.,Glaucoma Unit, Hospital Medicina dos Olhos, Osasco, São Paulo, Brazil
| |
Collapse
|
25
|
Dias DT, Ushida M, Sousa MC, Dorairaj S, Biteli LG, Leite MT, Paranhos A, Prata TS. Eyes with Suspicious Appearance of the Optic Disc and Normal Intraocular Pressure: Using Clinical and Epidemiological Characteristics to Differentiate Those with and without Glaucoma. PLoS One 2016; 11:e0158983. [PMID: 27433805 PMCID: PMC4951128 DOI: 10.1371/journal.pone.0158983] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 06/25/2016] [Indexed: 11/23/2022] Open
Abstract
Among all glaucoma suspects, eyes with optic nerve head features suspicious or suggestive of early glaucoma are probably those that offer the greatest challenge for clinicians. In contrast with the robust longitudinal data published on ocular hypertension, there is no specific management guideline for these patients. Therefore, evaluating eyes with suspicious optic disc appearance and normal intraocular pressure (IOP), we sought to investigate potential differences in clinical and epidemiological characteristics to differentiate those with normal-tension glaucoma (NTG) from those with presumed large physiological optic disc cups (pLPC). In this observational case-control study, we consecutively enrolled individuals with pLPC and NTG. All eyes had vertical cup-to-disc ratio (VCDR)≥0.6 and untreated IOP<21 mmHg. Glaucomatous eyes had reproducible visual field defects. Eyes with pLPC required normal visual fields and ≥30 months of follow-up with no evidence of glaucomatous neuropathy. Clinical and epidemiological parameters were compared between groups. Eighty-four individuals with pLPC and 40 NTG patients were included. Regarding our main results, NTG patients were significantly older and with a higher prevalence of Japanese descendants (p<0.01). Not only did pLPC eyes have smaller mean VCDR, but also larger optic discs (p≤0.04). There were no significant differences for gender, central corneal thickness, and spherical equivalent (p≥0.38). Significant odds ratios (OR) were found for race (OR = 2.42; for Japanese ancestry), age (OR = 1.05), VCDR (OR = 5.03), and disc size (OR = 0.04; p≤0.04). In conclusion, in patients with suspicious optic disc and normal IOP, those with older age, Japanese ancestry, smaller optic discs, and larger VCDR are more likely to have NTG, and therefore, deserve deeper investigation and closer monitoring.
Collapse
Affiliation(s)
- Diego T. Dias
- Department of Ophthalmology, Federal University of São Paulo, São Paulo, São Paulo, Brazil
- Glaucoma Unit, Hospital Medicina dos Olhos, Osasco, São Paulo, Brazil
| | - Michele Ushida
- Department of Ophthalmology, Federal University of São Paulo, São Paulo, São Paulo, Brazil
- Glaucoma Unit, Hospital Medicina dos Olhos, Osasco, São Paulo, Brazil
| | - Marina C. Sousa
- Department of Ophthalmology, Federal University of São Paulo, São Paulo, São Paulo, Brazil
| | - Syril Dorairaj
- Department of Ophthalmology, Mayo Clinic, Jacksonville, Florida, United States of America
- * E-mail:
| | - Luis G. Biteli
- Department of Ophthalmology, Federal University of São Paulo, São Paulo, São Paulo, Brazil
- Glaucoma Unit, Hospital Medicina dos Olhos, Osasco, São Paulo, Brazil
| | - Mauro T. Leite
- Department of Ophthalmology, Federal University of São Paulo, São Paulo, São Paulo, Brazil
| | - Augusto Paranhos
- Department of Ophthalmology, Federal University of São Paulo, São Paulo, São Paulo, Brazil
| | - Tiago S. Prata
- Department of Ophthalmology, Federal University of São Paulo, São Paulo, São Paulo, Brazil
- Glaucoma Unit, Hospital Medicina dos Olhos, Osasco, São Paulo, Brazil
| |
Collapse
|
26
|
Kanadani FN, Moreira T, Bezerra B, Vianello MP, Corradi J, Dorairaj SK, Prata TS. Diurnal Curve of the Ocular Perfusion Pressure. J Curr Glaucoma Pract 2016; 10:4-6. [PMID: 27231413 PMCID: PMC4875728 DOI: 10.5005/jp-journals-10008-1195] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2015] [Accepted: 12/20/2015] [Indexed: 11/23/2022] Open
Abstract
Purpose: To describe the diurnal variation of the ocular perfusion pressure (OPP) in normal, suspects and glaucoma patients. Materials and methods: Seventy-nine subjects were enrolled in a prospective study. The diurnal curve of intraocular pressure (IOP) was performed and blood pressure measurements were obtained. Each participant was grouped into one of the following based upon the clinical evaluation of the optic disk, IOP and standard achromatic perimetry (SAP): 18 eyes were classified as normal (normal SAP, normal optic disk evaluation and IOP < 21 mm Hg in two different measurements), 30 eyes as glaucoma suspect (GS) (normal SAP and mean deviation (MD), C/D ration > 0.5 or asymmetry > 0.2 and/or ocular hypertension), 31 eyes as early glaucoma (MD < -6 dB, glaucomatous optic neuropathy and SAP and MDs on SAP. Standard achromatic perimetry was performed with the Octopus 3.1.1 Dynamic 24-2 program. Intraocular pressure and blood pressure measurements were taken at 6 am, 9 am, 12, 3 and 6 pm. The patients stayed in the seated position for 5 minutes prior to blood pressure measurements. Results: The mean IOP values in all groups did not follow any regular pattern. The peak IOP was found to be greater in suspect [18.70 ± 3.31 (mm Hg ± SD)] and glaucoma (18.77 ± 4.30 mm Hg) patients as compared to normal subjects (16.11 ± 2.27 mm Hg). In studying the diurnal variation of the OPP, we found lower values at 3 pm in normals (34.21 ± 2.07 mm Hg), at 9 am in suspects (54.35 ± 3.32 mm Hg) and at 12 pm in glaucoma patients (34.84 ± 1.44 mm Hg). Conclusion: Each group has a specific OPP variation during the day with the most homogeneous group being the suspect one. It is important to keep studying the IOP and OPP variation for increased comprehension of the pathophysiology of glaucomatous optic neuropathy. How to cite this article: Kanadani FN, Moreira TCA, Bezerra BSP, Vianello MP, Corradi J, Dorairaj SK, Prata TS. Diurnal Curve of the Ocular Perfusion Pressure. J Curr Glaucoma Pract 2016;10(1):4-6.
Collapse
Affiliation(s)
- Fabio N Kanadani
- Chief, Department of Glaucoma, Medical Science University Hospital, Belo Horizonte, Brazil
| | - Tca Moreira
- Assistant Professor, Department of Retina, Medical Science University Hospital, Belo Horizonte, Brazil
| | - Bsp Bezerra
- Assistant Professor, Department of Glaucoma, Medical Science University Hospital, Belo Horizonte, Brazil
| | - M P Vianello
- Assistant Professor, Department of Glaucoma, Medical Science University Hospital, Belo Horizonte, Brazil
| | - J Corradi
- Assistant Professor, Department of Glaucoma, Medical Science University Hospital, Belo Horizonte, Brazil
| | - S K Dorairaj
- Assistant Professor, Department of Ophthalmology/Glaucoma, Mayo Clinic, Jacksonville, Florida, USA
| | - T S Prata
- Assistant Professor, Department of Glaucoma, Federal University of Sao Paulo Sao Paulo, Brazil
| |
Collapse
|
27
|
Sousa MC, Biteli LG, Dorairaj S, Maslin JS, Leite MT, Prata TS. Suitability of the Visual Field Index according to Glaucoma Severity. J Curr Glaucoma Pract 2016; 9:65-8. [PMID: 26997838 PMCID: PMC4779942 DOI: 10.5005/jp-journals-10008-1186] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 09/22/2015] [Indexed: 12/03/2022] Open
Abstract
Purpose: To investigate the suitability of the visual field index (VFI) in different degrees of disease severity in glaucoma patients. Methods: In this cross-sectional study, we consecutively enrolled patients with primary open-angle glaucoma and glaucoma suspects (ocular hypertension). All eyes required a reliable standard automated perimetry (SAP) test to be included. Subjects were categorized into five groups based on glaucoma severity using SAP’s mean deviation (MD). To evaluate the correlation among VFI, MD and pattern standard deviation (PSD), a linear regression model was built. To evaluate the nature of the correlation (i.e. linear vs nonlinear), results were plotted in a scatterplot graph. Results: One hundred and twenty-two eyes of 81 patients (mean age, 59.8 ± 14.5 years) were included. A strong, positive association was found between MD and VFI values (R2 = 0.98, p < 0.001), showing a 3.2% reduction in the VFI for each dB loss in the MD index. It was noticed that 15% of eyes with mild glaucoma (average MD of -3.1 dB) had VFI > 99%. Considering only the eyes with mild and moderate damage in the regression, we found a weaker (nonlinear) correlation than the one we found using all eyes (R2 = 0.85, p < 0.001). There was also a significant, nonlinear correlation between VFI and PSD (R2 = 0.85, p < 0.001). Although higher PSD values were found with increasing visual field damage, this initial trend was reversed when VFI became smaller than 50%, approximately. Conclusion: Visual field index had a strong correlation with MD; however, this correlation was weaker in mild disease, as some patients with early disease had very high VFI values (ceiling effect). Therefore, initial deterioration in visual field status (as assessed by MD values) in patients with early disease may not be detectable using the VFI alone. How to cite this article: Sousa MCC, Biteli LG, Dorairaj S, Maslin JS, Leite M, Prata TS. Suitability of the Visual Field Index according to Glaucoma Severity. J Curr Glaucoma Pract 2015;9(3):65-68.
Collapse
Affiliation(s)
- Marina Cc Sousa
- Resident, Department of Ophthalmology, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Luis G Biteli
- Preceptor, Glaucoma Service, Department of Ophthalmology, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Syril Dorairaj
- Associate Professor, Department of Ophthalmology, Mayo Clinic, Florida, USA
| | - Jessica S Maslin
- Resident, Department of Ophthalmology and Visual Science, Yale University School of Medicine, CT, USA
| | - Mauro T Leite
- Medical Staff, Glaucoma Service, Department of Ophthalmology, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Tiago S Prata
- Assistant Professor, Department of Ophthalmology, Federal University of Sao Paulo, Sao Paulo, Brazil
| |
Collapse
|
28
|
Junqueira DM, Lopes FS, de Souza FC, Dorairaj S, Prata TS. Evaluation of the efficacy and safety of a new device for eye drops instillation in patients with glaucoma. Clin Ophthalmol 2015; 9:367-71. [PMID: 25750514 PMCID: PMC4348048 DOI: 10.2147/opth.s78743] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Objective This study evaluated the efficacy and safety of a new device (Eyedrop®) designed for eye drop instillation in patients with and without glaucoma. Methods This prospective study included consecutive patients with glaucoma and healthy participants. After a complete eye examination and determination of baseline intraocular pressure (IOP), topical hypotensive medication was introduced in both eyes, and the Eyedrop® delivery device (a plastic device in which the bottle with eye drops is inserted) was made available to all participants (with video and written instructions) for use in one eye, randomly chosen. In the second phase, all patients were evaluated by an experienced examiner for IOP determination, investigation of possible associated side effects, and ease of instilling eye drops (by a visual analog scale [VAS]; 0–10). Results Thirty two participants (mean age 42.3±16.2 years) were evaluated. Of these, 44% had glaucoma. There was no significant difference in mean IOP variation when comparing the eye using (−3.9±2.9 mmHg) or not using the device (−3.3±2.6 mmHg; P=0.36). The subjective rating of the facility of drops instillation was significantly higher with the Eyedrop® applicator (VAS =7.6±1.6) than without it (VAS =6.2±1.8; P<0.01), with a higher frequency of positive device-related evaluations (VAS score >5) among participants without prior experience with eye drop instillation (78.6% [11/14]) versus those already experienced (66.7% [12/18]). No difference in the frequency of side effects or in the distribution pattern of fluorescein between eyes was observed (P≥0.63). Conclusion Eyedrop® received a better subjective response regarding the ease of instillation of hypotensive eye drops compared to traditional instillation, especially in patients with no previous experience with eye drops. Using the device did not result in any loss of hypotensive effect or increase in the frequency of side effects.
Collapse
Affiliation(s)
| | - Flavio S Lopes
- Glaucoma Unit, Hospital Medicina dos Olhos, Osasco, Brazil ; Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil
| | | | - Syril Dorairaj
- Department of Ophthalmology, Mayo Clinic, Jacksonville, FL, USA
| | - Tiago S Prata
- Glaucoma Unit, Hospital Medicina dos Olhos, Osasco, Brazil ; Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil
| |
Collapse
|
29
|
Bernardo WM, Prata TS, Kanadani FN, Simões R. Update on angle-closure glaucoma: treatment. Rev Assoc Med Bras (1992) 2014. [DOI: 10.1590/1806-9282.60.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
|
30
|
Prata TS, Dorairaj S, Trancoso L, Kanadani FN, Biteli LG, Furlanetto R, Lopes FS, Leite MT. Eyes with large disc cupping and normal intraocular pressure: using optical coherence tomography to discriminate those with and without glaucoma. Med Hypothesis Discov Innov Ophthalmol 2014; 3:91-8. [PMID: 25741525 PMCID: PMC4348491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
We evaluated the ability of spectral-domain optic coherence tomography (SD-OCT) to differentiate large physiological optic disc cupping (LPC) from glaucomatous cupping in eyes with intraocular pressure (IOP) within the normal range. We prospectively enrolled patients with glaucoma or presumed LPC. Participants had optic discs with confirmed or suspected glaucomatous damage (defined as a vertical cup-to-disc ratio≥0.6), and all eyes had known untreated IOP<21 mmHg. For glaucomatous eyes, a reproducible glaucomatous visual field (VF) defect was required. LPC eyes required normal VF and no evidence of progressive glaucomatous neuropathy (follow-up≥30 months). Peripapillary retinal nerve fiber layer (pRNFL) and macular ganglion cell complex (GCC) thicknesses were obtained using SD-OCT. For all studied parameters of pRNFL and GCC thicknesses, eyes with glaucoma (n=36) had significantly thinner values compared to eyes with LPC (n=71; P<0.05 for all comparisons). In addition, pRNFL parameters had sensitivity of 66.7% and specificity of 83.1%, and GCC parameters had sensitivity of 61.2% and specificity of 81.7%. The combination of the two analyses increased the sensitivity to 80.6%. In conclusion, while evaluating patients with large optic disc cupping and IOP in the statistically normal range, SD-OCT had only limited diagnostic ability to differentiate those with and without glaucoma. Although the diagnostic ability of the pRNFL and the GCC scans were similar, these parameters yielded an increase in sensitivity when combined, suggesting that both parameters could be considered simultaneously in these cases.
Collapse
Affiliation(s)
- Tiago S. Prata
- Federal University of São Paulo, Rua Sena Madureira, 1500 - Vila Mariana, São Paulo - SP, 04021-001, Brazil,Glaucoma Unit, Hospital Medicina dos Olhos, Rua Salém Bechara, 297 - Centro, Osasco - SP, 06018-180, Brazil
| | - Syril Dorairaj
- Department of Ophthalmology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, Florida, 32224, USA
| | - Luisa Trancoso
- Glaucoma Unit, Hospital Medicina dos Olhos, Rua Salém Bechara, 297 - Centro, Osasco - SP, 06018-180, Brazil
| | - Fabio N. Kanadani
- Federal University of São Paulo, Rua Sena Madureira, 1500 - Vila Mariana, São Paulo - SP, 04021-001, Brazil
| | - Luis G. Biteli
- Federal University of São Paulo, Rua Sena Madureira, 1500 - Vila Mariana, São Paulo - SP, 04021-001, Brazil,Glaucoma Unit, Hospital Medicina dos Olhos, Rua Salém Bechara, 297 - Centro, Osasco - SP, 06018-180, Brazil
| | - Rafael Furlanetto
- Federal University of São Paulo, Rua Sena Madureira, 1500 - Vila Mariana, São Paulo - SP, 04021-001, Brazil
| | - Flavio S. Lopes
- Federal University of São Paulo, Rua Sena Madureira, 1500 - Vila Mariana, São Paulo - SP, 04021-001, Brazil,Glaucoma Unit, Hospital Medicina dos Olhos, Rua Salém Bechara, 297 - Centro, Osasco - SP, 06018-180, Brazil
| | - Mauro T. Leite
- Federal University of São Paulo, Rua Sena Madureira, 1500 - Vila Mariana, São Paulo - SP, 04021-001, Brazil
| |
Collapse
|
31
|
Junqueira DLM, Prado VG, Lopes FS, Biteli LG, Dorairaj S, Prata TS. Non-pupillary block angle-closure mechanisms: a comprehensive analysis of their prevalence and treatment outcomes. Arq Bras Oftalmol 2014; 77:360-3. [DOI: 10.5935/0004-2749.20140090] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Accepted: 10/21/2014] [Indexed: 11/20/2022] Open
|
32
|
Prata TS, Dorairaj S, De Moraes CGV, Mehta S, Sbeity Z, Tello C, Liebmann J, Ritch R. Is preoperative ciliary body and iris anatomical configuration a predictor of malignant glaucoma development? Clin Exp Ophthalmol 2013; 41:541-5. [PMID: 23279576 DOI: 10.1111/ceo.12057] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2012] [Accepted: 11/30/2012] [Indexed: 11/27/2022]
Abstract
BACKGROUND To investigate anatomical configuration of ciliary body and iris using ultrasound biomicroscopy as a predictor of malignant glaucoma development. DESIGN Retrospective study in a tertiary care hospital. PARTICIPANTS Cohort of 31 consecutive patients diagnosed with post-surgical malignant glaucoma. METHODS Anterior chamber angle, iris and ciliary body configuration of involved eyes that had ultrasound biomicroscopy evaluation prior to the malignant glaucoma onset were evaluated. In cases with no presurgical ultrasound biomicroscopy exam of the involved eye, images from the fellow eye (imaged within 6 months) were analysed. MAIN OUTCOME MEASURES Qualitative parameters. RESULTS Thirty-one eyes (31 patients) had confirmed malignant glaucoma between 1996 and 2008. Most patients were women (65%) and had an anatomical narrow angle or angle-closure glaucoma (77%). Mean intraocular pressure at diagnosis was 30.4 ± 13.5 mmHg. The most common operation was trabeculectomy with mitomycin C (55%, 17/31 eyes), combined (3/17) or not (14/17) with cataract extraction and intraocular lens implantation. Among these 31 cases, we were able to evaluate the ultrasound biomicroscopy images of 13 patients (13 eyes) including involved eyes imaged prior to the malignant glaucoma onset or eligible fellow eyes. A narrow angle with or without iridotrabecular contact was found in all eyes. A large and/or anteriorly positioned ciliary body associated with an iris root angulating forward and centrally, revealing a plateau iris configuration, was noticed in 85% (11/13) of these eyes. CONCLUSION Identification of plateau iris configuration by ultrasound biomicroscopy should be considered as a possible predictor of post-operative malignant glaucoma development.
Collapse
Affiliation(s)
- Tiago S Prata
- Einhorn Clinical Research Center, New York Eye and Ear Infirmary, New York, NY 10003, USA
| | | | | | | | | | | | | | | |
Collapse
|
33
|
Prata TS, Lima VC, Guedes LM, Biteli LG, Teixeira SH, de Moraes CG, Ritch R, Paranhos A. Association between corneal biomechanical properties and optic nerve head morphology in newly diagnosed glaucoma patients. Clin Exp Ophthalmol 2013; 40:682-8. [PMID: 22429725 DOI: 10.1111/j.1442-9071.2012.02790.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND To investigate the association between corneal biomechanics and optic nerve head morphology in newly diagnosed primary open-angle glaucoma patients. DESIGN Hospital based prospective study. PARTICIPANTS Forty-two untreated newly diagnosed primary open-angle glaucoma patients. METHODS Patients underwent corneal hysteresis measurement using the Ocular Response Analyzer and confocal scanning laser ophthalmoscopy for optic nerve head topography evaluation. One eye was selected randomly for analysis. Data collected included age, race, gender, intraocular pressure and central corneal thickness. MAIN OUTCOME MEASURES Multiple regression analysis (controlling for baseline intraocular pressure and disc area) was used to investigate factors associated with the following optic nerve head topographic parameters: linear cup-to-disc ratio and mean cup depth. RESULTS Mean age of participants was 66.7 ± 11.8 years. Corneal hysteresis was the only factor significantly associated with both mean cup depth (correlation coefficient [r] = -0.34, P = 0.03) and cup-to-disc ratio (r = -0.41, P = 0.01). Central corneal thickness was significantly associated with mean cup depth (r = -0.35, P = 0.02), but not with cup-to-disc ratio (r = -0.25, P = 0.13). Although a trend towards a positive association between age and cup-to-disc ratio was identified (r = 0.26, P = 0.08), age was not significantly associated with mean cup depth (r = 0.06, P = 0.72). When comparing fellow eyes of patients with bilateral glaucoma, the eye with higher corneal hysteresis had smaller cup-to-disc ratio in 75% of the cases. CONCLUSIONS In untreated newly diagnosed primary open-angle glaucoma patients, those with thinner corneas and mainly lower corneal hysteresis values had a larger cup-to-disc ratio and deeper cup, independently of intraocular pressure values and disc size.
Collapse
Affiliation(s)
- Tiago S Prata
- Department of Ophthalmology, Federal University of São Paulo Hospital Medicina dos Olhos, São Paulo, Brazil.
| | | | | | | | | | | | | | | |
Collapse
|
34
|
Lima VC, Prata TS, Castro DPE, Castro LC, De Moraes CGV, Mattox C, Rosen RB, Liebmann JM, Ritch R. Macular changes detected by Fourier-domain optical coherence tomography in patients with hypotony without clinical maculopathy. Acta Ophthalmol 2011; 89:e274-7. [PMID: 19906084 DOI: 10.1111/j.1755-3768.2009.01719.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE To investigate macular changes in eyes with postoperative hypotony without clinical maculopathy using high-resolution Fourier-domain optical coherence tomography (FD-OCT). METHODS Fourteen eyes of 12 patients with postoperative intraocular pressure (IOP) £ 6 mmHg for at least 4 weeks but with no detectable clinical features associated with hypotony maculopathy were imaged by FD-OCT prospectively. Images were analysed by two retina specialists masked to clinical findings. RESULTS Most patients were female (83%) and myopic (75%) with a mean age of 65 ± 17 [standard deviation (SD)] years (range 2–86 years). Mean central corneal thickness was 519 ± 34 lm [95% confidence interval (CI) 502–537] and mean IOP before surgery was 20 ± 8 mmHg (95% CI 15–24). During the period of hypotony (mean 15 ± 6 weeks), the average mean IOP was 4 ± 1 mmHg (95% CI 3–5). Abnormal FD-OCT findings (retinal folds and ⁄ or intraretinal fluid) were present in eight eyes. These patients had a higher rate of visual symptoms (75% versus 17%), visual acuity loss (‡ 2 lines; 63% versus 17%) and increased mean foveal thickness (250 ± 26 versus 210 ± 12 lm; p < 0.01, Mann–Whitney U-test) compared with those with normal FD-OCT. CONCLUSION FD-OCT identified subclinical macular abnormalities in over half of the eyes with postoperative hypotony. These findings were accompanied by visual disturbances and central macular thickening. FD-OCT can be an important diagnostic tool for this disorder when clinical features are absent.
Collapse
Affiliation(s)
- Verônica C Lima
- Retina Service, New York Eye and Ear Infirmary, New York, NY 10003, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
35
|
Prata TS, Lima VC, de Moraes CGV, Guedes LM, Magalhães FP, Teixeira SH, Ritch R, Paranhos A. Factors associated with topographic changes of the optic nerve head induced by acute intraocular pressure reduction in glaucoma patients. Eye (Lond) 2010; 25:201-7. [PMID: 21127505 DOI: 10.1038/eye.2010.179] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To investigate factors associated with changes in optic nerve head (ONH) topography after acute intraocular pressure (IOP) reduction in patients with primary open-angle glaucoma (POAG). METHODS Untreated POAG patients (IOP >21 mm Hg) were prospectively enrolled. Systemic and ocular information were collected, including central corneal thickness (CCT) and corneal hysteresis (CH). All patients underwent confocal scanning laser ophthalmoscopy and tonometry (Goldmann) before and 1 h after pharmacological IOP reduction. The mean of three measurements was considered for analysis. Changes in each ONH topographic parameter were assessed (one eye was randomly selected), and those that changed significantly were correlated with patient's systemic and ocular characteristics. RESULTS A total of 42 patients were included (mean age, 66.7 ± 11.8 years). After a mean IOP reduction of 47.3 ± 11.9%, significant changes were observed in cup area and volume, and in rim area and volume (P < 0.01), but not in mean cup depth (P = 0.80). Multiple regression analysis (controlling for baseline IOP and magnitude of IOP reduction) showed that CH (r(2) = 0.17, P < 0.01) and diabetes diagnosis (r(2) ≥ 0.21, P < 0.01) were negatively correlated with the magnitude of changes in ONH parameters, whereas the cup-to-disc ratio was positively correlated (r(2) = 0.30, P < 0.01). Age, race, disc area, and CCT were not significant (P ≥ 0.12). Including all significant factors in a multivariable model, only the presence of diabetes remained significantly associated with all ONH parameters evaluated (P < 0.01). CONCLUSIONS Different systemic and ocular factors, such as diabetes, CH, and the relative size of the cup, seem to be associated with the magnitude of changes in ONH topography after acute IOP reduction in POAG patients. These associations partially explain the ONH changes observed in these patients and suggest that other factors are possibly implicated in an individual susceptibility to IOP.
Collapse
Affiliation(s)
- T S Prata
- Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil.
| | | | | | | | | | | | | | | |
Collapse
|
36
|
de Beaufort HC, De Moraes CGV, Teng CC, Prata TS, Tello C, Ritch R, Liebmann JM. Response to: “Morphologic and functional glaucomatous change after occurrence of single or recurrent optic disc haemorrhages”. Graefes Arch Clin Exp Ophthalmol 2010. [DOI: 10.1007/s00417-010-1475-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
|
37
|
Amini R, whitcomb JE, Prata TS, Dorairaj S, Liebmann JM, Ritch R, Barocas VH. Quantification of iris concavity. J Ophthalmic Vis Res 2010; 5:211-2. [PMID: 22737360 PMCID: PMC3379916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Affiliation(s)
- Rouzbeh Amini
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, Minnesota, USA
| | - Julie E whitcomb
- Department of Mechanical Engineering, University of Minnesota, Minneapolis, Minnesota, USA
| | - Tiago S Prata
- Einhorn Clinical Research Center, New York Eye and Ear Infirmary, New York, New York, USA
| | - Syril Dorairaj
- Einhorn Clinical Research Center, New York Eye and Ear Infirmary, New York, New York, USA
| | - Jeffrey M Liebmann
- Einhorn Clinical Research Center, New York Eye and Ear Infirmary, New York, New York, USA,New York University School of Medicine, New York, New York, USA
| | - Robert Ritch
- Einhorn Clinical Research Center, New York Eye and Ear Infirmary, New York, New York, USA,Department of Ophthalmology, New York Medical College, Valhalla, New York, USA
| | - Victor H Barocas
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, Minnesota, USA,Correspondence to: Victor H Barocas, PhD. Professor of Biomedical Engineering, Department of Biomedical Engineering, University of Minnesota, 7-105 Nils Hasselmo Hall, 312 Church St SE, Minneapolis, MN 55455, USA; Tel: +1 (612) 626-5572, Fax: +1 (612) 626-6583; e-mail:
| |
Collapse
|
38
|
Folgar FA, de Moraes CGV, Prata TS, Teng CC, Tello C, Ritch R, Liebmann JM. Glaucoma surgery decreases the rates of localized and global visual field progression. Am J Ophthalmol 2010; 149:258-264.e2. [PMID: 20103054 DOI: 10.1016/j.ajo.2009.09.010] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2009] [Revised: 09/14/2009] [Accepted: 09/16/2009] [Indexed: 10/20/2022]
Abstract
PURPOSE Incisional glaucoma surgical procedures produce greater intraocular pressure (IOP) reduction and less IOP variability than medical treatment. We sought to determine the efficacy of glaucoma surgery in decreasing localized and global rates of visual field (VF) progression. DESIGN Retrospective, interventional case series. METHODS Subjects in the New York Glaucoma Progression Study with glaucomatous optic neuropathy, repeatable VF loss, and 10 or more Swedish interactive threshold algorithm standard VF examinations were assessed for eligibility. Patients who underwent successful glaucoma surgery (not requiring further surgical intervention and IOP < 18 mm Hg) in either eye and who were followed up for at least 2 years before and after surgery were enrolled. Automated pointwise linear regression analysis was used to calculate global and localized rates of progression before and after surgery. Eyes with other ocular conditions likely to affect the VF and an insufficient number of VF to create a slope before and after surgery were excluded. Comparisons were performed within the same eyes before and after surgery (Student paired t test). RESULTS We enrolled 28 eyes of 28 patients (mean age, 61.2 +/- 14.5 years). The mean number +/- standard deviation of VF was 13.4 +/- 2.3, spanning 7.1 +/- 1.2 years (range, 4 to 9 years). Mean IOP +/- standard deviation decreased from 19.0 +/- 3.9 mm Hg before surgery to 11.3 +/- 3.7 mm Hg after surgery (40% reduction; P < .01). Mean global progression rates decreased from -1.48 +/- 1.4 dB/year before surgery to -0.43 +/- 0.8 dB/year after surgery (70% reduction; P = .01). Twelve eyes (42.8%) had at least 1 significantly progressing point before surgery, whereas only 2 (7.1%) had at least 1 progressing point after surgery. Each 1 mm Hg of IOP reduction after surgery resulted in a 0.1 dB/year decrease in the global rate of progression. CONCLUSIONS Successful IOP reduction after glaucoma surgery greatly reduces both the number of progressing points and the localized and general rates of VF progression.
Collapse
|
39
|
Ritch R, Prata TS, de Moraes CGV, Vessani RM, Costa VP, Konstas AGP, Liebmann JM, Schlötzer-Schrehardt U. Association of exfoliation syndrome and central retinal vein occlusion: an ultrastructural analysis. Acta Ophthalmol 2010; 88:91-5. [PMID: 19725816 DOI: 10.1111/j.1755-3768.2009.01578.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
PURPOSE To evaluate prospectively the frequency with which exfoliation syndrome (XFS) occurs in patients with central retinal vein occlusion (CRVO) by clinical examination and ultrastructural examination of conjunctival biopsy specimens. METHODS Prospective observational case series. Thirty-six eyes of 36 consecutive patients with CRVO were investigated for XFS by slit-lamp examination and conjunctival biopsy when XFS was not clinically visible on examination. RESULTS A clinical diagnosis of XFS or a positive biopsy result for exfoliation material (XFM) was present in 22 of the 36 patients (61%; 95% confidence interval 45-75%). Twelve of these 22 patients (54%) had a clinical diagnosis of XFS. Aggregates of XFM were identified ultrastructurally in the biopsy specimens in 10 of 24 patients with no clinical signs of XFS (42%). Patients with and without XFS had similar distribution of age, gender, race and prevalence of systemic disorders. Twelve of the 22 (54%) XFS patients had neither glaucoma nor ocular hypertension prior to the CRVO. CONCLUSION In accordance with previous retrospective and histological studies, this prospective, in vivo study suggests that CRVO is commonly associated with XFS.
Collapse
Affiliation(s)
- Robert Ritch
- Department of Ophthalmology, Einhorn Clinical Research Center, New York Eye and Ear Infirmary, New York City 10003, USA.
| | | | | | | | | | | | | | | |
Collapse
|
40
|
Tello C, De Moraes CGV, Prata TS, Derr P, Patel J, Siegfried J, Liebmann JM, Ritch R. Repeatability of short-duration transient visual evoked potentials in normal subjects. Doc Ophthalmol 2010; 120:219-28. [PMID: 20111979 PMCID: PMC2869044 DOI: 10.1007/s10633-010-9216-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2009] [Accepted: 01/07/2010] [Indexed: 11/27/2022]
Abstract
To evaluate the within-session and inter-session repeatability of a new, short-duration transient visual evoked potential (SD-tVEP) device on normal individuals, we tested 30 normal subjects (20/20 visual acuity, normal 24-2 SITA Standard VF) with SD-tVEP. Ten of these subjects had their tests repeated within 1–2 months from the initial visit. Synchronized single-channel EEG was recorded using a modified Diopsys Enfant™ System (Diopsys, Inc., Pine Brook, New Jersey, USA). A checkerboard stimulus was modulated at two reversals per second. Two different contrasts of checkerboard reversal patterns were used: 85% Michelson contrast with a mean luminance of 66.25 cd/m2 and 10% Michelson contrast with a mean luminance of 112 cd/m2. Each test lasted 20 s. Both eyes, independently and together, were tested 10 times (5 times at each contrast level). The following information was identified from the filtered N75-P100-N135 complex: N75 amplitude, N75 latency, P100 amplitude, P100 latency, and Delta Amplitude (N75-P100). The median values for each eye’s five SD-tVEP parameters were calculated and grouped into two data sets based on contrast level. Mean age was 27.3 ± 5.2 years. For OD only, the median (95% confidence intervals) of Delta Amplitude (N75-P100) amplitudes at 10% and 85% contrast were 4.6 uV (4.1–5.9) and 7.1 uV (5.15–9.31). The median P100 latencies were 115.2 ms (112.0–117.7) and 104.0 ms (99.9–106.0). There was little within-session variability for any of these parameters. Intraclass correlation coefficients ranged between 0.64 and 0.98, and within subject coefficients of variation were 3–5% (P100 latency) and 15–30% (Delta Amplitude (N75-P100) amplitude). Bland–Altman plots showed good agreement between the first and fifth test sessions (85% contrast Delta Amplitude (N75-P100) delta amplitude, mean difference, 0.48 mV, 95% CI, −0.18–1.12; 85% contrast P100 latency delay, −0.82 ms, 95% CI, −3.12–1.46; 10% contrast Delta Amplitude (N75-P100) amplitude, 0.58 mV, 95% CI, −0.27–1.45; 10% contrast P100 latency delay, −2.05 mV, 95% CI, −5.12–1.01). The inter-eye correlation and agreement were significant for both SD-tVEP amplitude and P100 latency measurements. For the subset of eyes in which the inter-session repeatability was tested, the intraclass correlation coefficients ranged between 0.71 and 0.86 with good agreement shown on Bland–Altman plots. Short-duration transient VEP technology showed good within-session, inter-session repeatability, and good inter-eye correlation and agreement.
Collapse
Affiliation(s)
- Celso Tello
- Department of Ophthalmology, Einhorn Clinical Research Center, New York Eye and Ear Infirmary, 310 East 14th Street, New York, NY 10003, USA.
| | | | | | | | | | | | | | | |
Collapse
|
41
|
Prata TS, De Moraes CGV, Teng CC, Tello C, Ritch R, Liebmann JM. Factors Affecting Rates of Visual Field Progression in Glaucoma Patients with Optic Disc Hemorrhage. Ophthalmology 2010; 117:24-9. [DOI: 10.1016/j.ophtha.2009.06.028] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2009] [Revised: 05/17/2009] [Accepted: 06/12/2009] [Indexed: 10/20/2022] Open
|
42
|
Ahrlich KG, De Moraes CGV, Teng CC, Prata TS, Tello C, Ritch R, Liebmann JM. Visual field progression differences between normal-tension and exfoliative high-tension glaucoma. Invest Ophthalmol Vis Sci 2009; 51:1458-63. [PMID: 20042657 DOI: 10.1167/iovs.09-3806] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
PURPOSE To compare the pattern, location, and rate of visual field (VF) change in normal-tension (NTG) and exfoliative high-tension glaucoma (XHTG). METHODS Records of all patients with glaucoma in the New York Glaucoma Progression Study with five or more VF tests were reviewed. Patients were divided into NTG (all known IOP < 21 mm Hg) and XHTG (untreated IOP >or= 21 mm Hg) groups. Automated pointwise linear regression analysis determined global and localized rates of change. RESULTS There were 139 NTG and 154 XHTG eyes. Patients with XHTG were significantly older than those with NTG (mean +/- SD: 72.6 +/- 9.4 years vs. 62.7 +/- 12.8 years, P < 0.01), had higher mean IOPs (16.5 +/- 3.2 mm Hg vs. 13.3 +/- 2.0 mm Hg, P < 0.01) and greater central corneal thickness (CCT, 544.0 +/- 35.7 microm vs. 533.9 +/- 35.9 microm; P = 0.01). During a similar period, XHTG progressed globally almost twice as rapidly as did NTG (-0.64 +/- 0.7 dB/y vs. -0.35 +/- 0.3 dB/y, P < 0.01), which became nonsignificant after adjustment for differences in age, mean IOP, and CCT. In a multivariate model, variables significantly associated with progression were higher mean IOP (odds ratio [OR]: 1.09, P = 0.03) and decreased CCT (OR/40 mum thinner: 1.37, P = 0.03). Progression within the paracentral VF was more common in the NTG group (75% vs. 57.3%, P = 0.04). The most important factor associated with paracentral progression among eyes that reached a progression outcome was the diagnosis of NTG. CONCLUSIONS XHTG and NTG eyes progress at a similar global rate after adjustment for differences in IOP, CCT, and age. However, NTG eyes progress more often in the central VF, independent of other factors. Glaucoma surveillance in eyes with open-angle glaucoma and statistically normal IOP should include periodic assessment of the central field.
Collapse
|
43
|
Prata TS, Sousa AK, Garcia Filho CAA, Doi LM, Paranhos A. Assessment of corneal biomechanical properties and intraocular pressure in patients with rheumatoid arthritis. Can J Ophthalmol 2009; 44:602. [PMID: 19789600 DOI: 10.3129/i09-082] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
|
44
|
De Moraes CGV, Prata TS, Liebmann CA, Tello C, Ritch R, Liebmann JM. Spatially Consistent, Localized Visual Field Loss before and after Disc Hemorrhage. ACTA ACUST UNITED AC 2009; 50:4727-33. [PMID: 19458330 DOI: 10.1167/iovs.09-3446] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
| | - Tiago S. Prata
- From the Einhorn Clinical Research Center, New York Eye and Ear Infirmary, New York, New York; the
| | - Craig A. Liebmann
- From the Einhorn Clinical Research Center, New York Eye and Ear Infirmary, New York, New York; the
| | - Celso Tello
- From the Einhorn Clinical Research Center, New York Eye and Ear Infirmary, New York, New York; the2Department of Ophthalmology, The New York Medical College, Valhalla, New York; the
| | - Robert Ritch
- From the Einhorn Clinical Research Center, New York Eye and Ear Infirmary, New York, New York; the2Department of Ophthalmology, The New York Medical College, Valhalla, New York; the
| | - Jeffrey M. Liebmann
- New York University School of Medicine, New York, New York; and the4Manhattan Eye, Ear and Throat Hospital, New York, New York
| |
Collapse
|
45
|
De Moraes CGV, Prata TS, Tello C, Ritch R, Liebmann JM. Glaucoma With Early Visual Field Loss Affecting Both Hemifields and the Risk of Disease Progression. ACTA ACUST UNITED AC 2009; 127:1129-34. [PMID: 19752421 DOI: 10.1001/archophthalmol.2009.165] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Carlos Gustavo V De Moraes
- Department of Ophthalmology, Einhorn Clinical Research Center, New York Eye and Ear Infirmary, New York, USA
| | | | | | | | | |
Collapse
|
46
|
Leite MT, Prata TS, Kera CZ, Miranda DV, de Moraes Barros SB, Melo LA. Ascorbic acid concentration is reduced in the secondary aqueous humour of glaucomatous patients. Clin Exp Ophthalmol 2009; 37:402-6. [PMID: 19594568 DOI: 10.1111/j.1442-9071.2009.02046.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND We aimed to evaluate the ascorbic acid concentration in secondary aqueous humour (AH) from glaucomatous patients and to compare it with primary AH from primary open-angle glaucoma patients and non-glaucomatous patients. METHODS Primary AH samples were prospectively obtained from clinically uncontrolled primary open-angle glaucoma patients and senile cataract patients (controls) prior to trabeculectomy and cataract surgery. Secondary AH samples were obtained from eyes with previous intraocular surgery, prior to trabeculectomy or cataract surgery. AH (0.1 mL) was aspirated by inserting a 26-gauge needle into the anterior chamber just before surgery and then immediately stored at -80 degrees C. The ascorbic acid concentration was determined in a masked fashion by high-pressure liquid chromatography. RESULTS A total of 18 patients with senile cataract, 16 glaucomatous patients with primary AH (no previous intraocular surgery) and 11 glaucomatous patients with secondary AH (previous intraocular surgery) were included. There was no difference in mean age between groups (P = 0.15). The mean +/- standard deviation concentration of ascorbic acid in the secondary AH from glaucomatous patients (504 +/- 213 micromol/L [95% confidence interval {CI}, 383-624]) was significantly lower than the concentration of ascorbic acid found in the primary aqueous of primary open-angle glaucoma (919 +/- 427 micromol/L [95% CI, 709-1128]) and control patients (1049 +/- 433 micromol/L [95% CI, 848-1249]; P < 0.01, Kruskal-Wallis test). CONCLUSIONS The ascorbic acid concentration in secondary AH of glaucomatous patients was approximately twofold lower in comparison with primary AH of glaucomatous and cataract patients. The implications of a reduced concentration of ascorbic acid in the secondary AH deserve further investigation.
Collapse
Affiliation(s)
- Mauro T Leite
- Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil
| | | | | | | | | | | |
Collapse
|
47
|
Lima VC, Prata TS, De Moraes CGV, Kim J, Seiple W, Rosen RB, Liebmann JM, Ritch R. A comparison between microperimetry and standard achromatic perimetry of the central visual field in eyes with glaucomatous paracentral visual-field defects. Br J Ophthalmol 2009; 94:64-7. [DOI: 10.1136/bjo.2009.159772] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
48
|
Lim MC, Tanimoto SA, Furlani BA, Lum B, Pinto LM, Eliason D, Prata TS, Brandt JD, Morse LS, Park SS, Melo LAS. Effect of diabetic retinopathy and panretinal photocoagulation on retinal nerve fiber layer and optic nerve appearance. ACTA ACUST UNITED AC 2009; 127:857-62. [PMID: 19597104 DOI: 10.1001/archophthalmol.2009.135] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To determine if panretinal photocoagulation (PRP) alters retinal nerve fiber layer (RNFL) thickness and optic nerve appearance. METHODS Patients with diabetes who did and did not undergo PRP and nondiabetic control subjects were enrolled in a prospective study. Participants underwent optical coherence tomography of the peripapillary retina and optic nerve. Stereoscopic optic nerve photographs were graded in a masked fashion. RESULTS Ninety-four eyes of 48 healthy individuals, 89 eyes of 55 diabetic patients who did not undergo PRP, and 37 eyes of 24 subjects with diabetes who underwent PRP were included in this study. Eyes that had been treated with PRP had thinner peripapillary RNFL compared with the other groups; this was statistically significantly different in the inferior (P = .004) and nasal (P = .003) regions. Optic nerve cupping did not increase with severity of disease classification, but the proportion of optic nerves graded as suspicious for glaucoma or as having nonglaucomatous optic neuropathy did (P = .008). These grading categories were associated with thinner RNFL measurements. CONCLUSIONS Diabetic eyes that have been treated with PRP have thinner RNFL than nondiabetic eyes. Optic nerves in eyes treated with PRP are more likely to be graded as abnormal, but their appearance is not necessarily glaucomatous and may be related to thinning of the RNFL.
Collapse
Affiliation(s)
- Michele C Lim
- Department of Ophthalmology & Vision Science, University of California-Davis, 4860 Y St, Ste 2400, Sacramento, CA 95817, USA.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
49
|
Canovas R, Lima VC, Garcia P, Morini C, Prata TS, Rosen RB. Comparison between macular pigment optical density measurements using two-wavelength autofluorescence and heterochromatic flicker photometry techniques. Invest Ophthalmol Vis Sci 2009; 51:3152-6. [PMID: 19578017 DOI: 10.1167/iovs.09-3608] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
PURPOSE The association of macular pigment (MP) with age-related macular degeneration has been extensively studied in recent years, and interest in a rapid, objective, and accurate technique to measure MP optical density (MPOD) has increased. The purpose of this study was to compare the MPOD values at specific loci around the fovea using the heterochromatic flicker photometry (HFP) and the two-wavelength autofluorescence (AF) methods in a young, healthy population. METHODS Ten patients (20 eyes) were enrolled. Subjects with any ocular or systemic disease were excluded. All patients underwent HFP and AF examination. The AF examination was performed using a modified scanning laser ophthalmoscope. Values for both devices were measured at four eccentricities around the fovea (0.25 degrees , 0.5 degrees, 1.0 degrees, and 1.75 degrees). Each eye was tested three times with each METHOD Statistical analysis was based on paired t-test and linear regression analysis. RESULTS At all retinal eccentricities, the HFP values were consistently lower than the HRA values (P < 0.001). There was, however, a significant correlation at almost all locations. The strongest correlation between two methods was found at 1.75 degrees from the center of the fovea (r = 0.73). CONCLUSIONS The modified-HRA AF method for MPOD generated results that were highly correlated with the standard HPF method but consistently higher at all eccentricities. These findings suggest that HRA can be reliably used in patients unable to perform HPF, which is important for wider clinical application of MP testing.
Collapse
Affiliation(s)
- Renata Canovas
- Retina Service, Department of Ophthalmology, The New York Eye and Ear Infirmary, New York, New York 10003, USA
| | | | | | | | | | | |
Collapse
|
50
|
Lima VC, Prata TS, Liebmann JM, Ritch R. Central retinal artery occlusion and non-arteritic anterior ischemic optic neuropathy associated with an overlap syndrome: a case report. J Med Case Rep 2008; 2:389. [PMID: 19091064 PMCID: PMC2630328 DOI: 10.1186/1752-1947-2-389] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2008] [Accepted: 12/17/2008] [Indexed: 11/11/2022] Open
Abstract
Introduction An "overlap syndrome" is defined as the sequential appearance over time of two or more risk factors for glaucomatous damage. The appearance of a new risk factor can alter the course and prognosis of previously stable disease. Exfoliation syndrome is a leading cause of glaucoma and is associated with vascular disease. We report a case of central retinal artery occlusion and non-arteritic anterior ischemic optic neuropathy in a patient with overlap syndrome. Case presentation An 87-year-old woman with longstanding stable primary open-angle glaucoma developed bilateral exfoliation syndrome, after which her intraocular pressure became uncontrolled and her glaucomatous damage progressed rapidly. She also developed ischemic arterial events in both eyes. Conclusion The case presented here shows that overlap syndromes can lead to rapid, irreversible vision impairment. To the best of our knowledge, this is the first reported case of central retinal artery occlusion and non-arteritic anterior ischemic optic neuropathy in a patient with overlap syndrome.
Collapse
Affiliation(s)
- Verônica C Lima
- Einhorn Clinical Research Center, The New York Eye and Ear Infirmary, New York, NY, USA.
| | | | | | | |
Collapse
|