Navegando por Palavras-chave "glaucoma"

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    Agreement on the evaluation of glaucomatous optic nerve head findings by ophthalmology residents and a glaucoma specialist
    (Dove Medical Press Ltd, 2017) Rossetto, Julia D. [UNIFESP]; Melo, Luiz Alberto S., Jr. [UNIFESP]; Campos, Mauro S. [UNIFESP]; Tavares, Ivan M. [UNIFESP]
    Objectives: To assess agreement among ophthalmology residents and a glaucoma expert in the evaluation of cross-sectional glaucomatous optic nerve head characteristics using stereoscopic photographs. Methods: Twenty stereo photographs were analyzed by ophthalmology residents just after completion of their first (First-Year Group) or third (Third-Year Group) year of residency and by a glaucoma expert. The agreement was assessed using the kappa statistic (.) and limits of agreement. Results: Agreement among resident groups and the expert ranged from poor to moderate. Agreement between Third Years and the expert seems to be better than that between First Years and the expert, especially in the evaluation of "nasal cupping", "barring circumlinear vessel," "notching", and "retinal nerve fiber layer defect" criteria. However, no improvement was seen in the agreement with the expert regarding glaucomatous optic neuropathy, which was 64% (kappa=0.19) for First Years and 63% (kappa= 0.20) for Third Years. Conclusion: Agreement between residents and the expert was poor to moderate and similar when comparing both groups. This may suggest that the residents learn how to identify glaucoma signals during the first year of training, and the results of this study may facilitate the creation of targeted teaching tools in residency training.
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    The amniotic membrane in ophthalmology
    (Elsevier B.V., 2004-01-01) Dua, H. S.; Gomes, José Álvaro Pereira [UNIFESP]; King, A. J.; Maharajan, V. S.; Univ Nottingham Hosp; Universidade Federal de São Paulo (UNIFESP)
    The amniotic membrane is the innermost of the three layers forming the fetal membranes. It was first used in 1910 in skin transplantation. Thereafter it has been used in surgical procedures related to the genito-urinary tract, skin, brain, and head and neck, among others. the first documented ophthalmological application was in the 1940s when it was used in the treatment of ocular burns. Following initial reports, its use in ocular surgery abated until recently when it was re-discovered in the Soviet Union and South America. Its introduction to North America in the early 1990s heralded a massive surge in the ophthalmic applications of this membrane. the reintroduction of amniotic membrane in ophthalmic surgery holds great promise; however, although it has been shown to be a useful and viable alternative for some conditions, it is Currently being used far in excess of its true useful potential. in many clinical situations it offers an alternative to existing management options without any distinct advantage over the others. Further studies will undoubtedly reveal the true potential of the membrane, its mechanism(s) of action, and the effective use of this tissue in ophthalmology. (C) 2004 Elsevier Inc. All rights reserved.
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    Ascorbic acid concentration is reduced in the secondary aqueous humour of glaucomatous patients
    (Wiley-Blackwell, 2009-05-01) Leite, Mauro T. [UNIFESP]; Prata, Tiago S. [UNIFESP]; Kera, Clarissa Z.; Miranda, Denise V.; Moraes Barros, Silvia B. de; Melo, Luiz A. S. [UNIFESP]; New York Eye & Ear Infirm; Universidade Federal de São Paulo (UNIFESP); Universidade de São Paulo (USP)
    P>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 mu mol/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 mu mol/L [95% CI, 709-1128]) and control patients (1049 +/- 433 mu mol/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.
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    Assessment of rates of structural change in glaucoma using imaging technologies
    (Nature Publishing Group, 2011-03-01) Mansouri, K.; Leite, Mauro Toledo [UNIFESP]; Medeiros, F. A.; Leung, C. K.; Weinreb, R. N.; Univ Calif San Diego; Univ Geneva; Universidade Federal de São Paulo (UNIFESP); Chinese Univ Hong Kong
    Purpose To review the ability of current imaging technologies to provide estimates of rates of structural change in glaucoma patients.Patients and methods Review of literature.Results Imaging technologies, such as confocal scanning laser ophthalmoscopy (CSLO), scanning laser polarimetry (SLP), and optical coherence tomography (OCT), provide quantifiable and reproducible measurements of the optic disc and parapapillary retinal nerve fibre layer (RNFL). Rates of change as quantified by the rim area (RA) (for CSLO) and RNFL thickness (for SLP and OCT) are related to glaucoma progression as detected by conventional methods (eg, visual fields and optic disc photography). Evidence shows that rates of RNFL and RA loss are significantly faster in progressing compared with non-progressing glaucoma patients.Conclusion Measurements of rates of optic disc and RNFL change are becoming increasingly precise and individualized. Currently available imaging technologies have the ability to detect and quantify progression in glaucoma, and their measurements may be suitable end points in glaucoma clinical trials. Eye (2011) 25, 269-277; doi:10.1038/eye.2010.202; published online 7 January 2011
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    Association between corneal biomechanical properties and optic nerve head morphology in newly diagnosed glaucoma patients
    (Wiley-Blackwell, 2012-09-01) Prata, Tiago S. [UNIFESP]; Lima, Veronica C.; Guedes, Lia M.; Biteli, Luis G.; Teixeira, Sergio H.; Moraes, Carlos G. de; Ritch, Robert; Paranhos, Augusto; Universidade Federal de São Paulo (UNIFESP); Hosp Med Olhos; New York Eye & Ear Infirm; New York Med Coll
    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.
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    Asymmetric Macular Structural Damage Is Associated With Relative Afferent Pupillary Defects in Patients With Glaucoma
    (Assoc Research Vision Ophthalmology Inc, 2016) Gracitelli, Carolina Pelegrini Barbosa [UNIFESP]; Tatham, Andrew J.; Zangwill, Linda M.; Weinreb, Robert N.; Abe, Ricardo Y.; Diniz-Filho, Alberto; Paranhos Junior, Augusto [UNIFESP]; Baig, Saif; Medeiros, Felipe A.
    PURPOSE. We examined the relationship between relative afferent pupillary defects (RAPDs) and macular structural damage measured by macular thickness and macular ganglion cell-inner plexiform layer (mGCIPL) thickness in patients with glaucoma. METHODS. A cross-sectional study was done of 106 glaucoma patients and 85 healthy individuals from the Diagnostic Innovations in Glaucoma Study. All subjects underwent standard automated perimetry (SAP) and optic nerve and macular imaging using Cirrus Spectral Domain Optical Coherence Tomography (SDOCT). Glaucoma was defined as repeatable abnormal SAP or progressive glaucomatous changes on stereo photographs. Pupil responses were assessed using an automated pupillometer, which records the magnitude of RAPD (RAPD score), with additional RAPD scores recorded for each of a series of colored stimuli (blue, red, green, and yellow). The relationship between RAPD score and intereye differences (right minus left eye) in circumpapillary retinal nerve fiber layer (cpRNFL) thickness, mGCIPL, macular thickness, and SAP mean deviation (MD), was examined using linear regression. RESULTS. There was fair correlation between RAPD score and asymmetric macular structural damage measured by intereye difference in mGCIPL thickness (R-2 = 0.285, P < 0.001). The relationship between RAPD score and intereye difference in macular thickness was weaker (R-2 = 0.167, P < 0.001). Intereye difference in cpRNFL thickness (R-2 = 0.350, P < 0.001) and SAP MD (R-2 = 0.594, P < 0.001) had stronger association with RAPD scores compared to intereye difference in mGCIPL and macular thickness. CONCLUSIONS. Objective assessment of pupillary responses using a pupillometer was associated with asymmetric macular structural damage in patients with glaucoma.
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    Avaliação da medida da hipotenusa da escavação vertical do nervo óptico utilizando o modo de imagem profunda realçada da tomografia de coerência óptica de domínio espectral: um potencial novo parâmetro estrutural na propedêutica do glaucoma
    (Universidade Federal de São Paulo (UNIFESP), 2016-08-30) Lavinsky, Fabio [UNIFESP]; Mello, Paulo Augusto de Arruda [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Purpose: To evaluate the measurement of the hypotenuse of the vertical optic nerve head cupping (HVOC) with the enhanced depth imaging (EDI) mode of the spectral domain optic coherence tomography (SD-OCT) as a novel structural parameter for glaucoma evaluation. Methods: We conducted a prospective, cross-sectional study with patients diagnosed with glaucoma and controls. Patients underwent SD-OCT evaluating the mean thickness of the retinal nerve fiber layer (RNFL) and the HVOC. One leg of the triangle represented the depth and the other leg represented the length of the cupping. These legs were manually measured. Patients also underwent color pictures and standard automated perimetry (SAP). The evaluation was performed in 85 patients (156 eyes). Patients were divided into three groups: 1) MD < -7 dB, 2) MD > -7 dB, and 3) patients without glaucoma. The structure-function evaluation and the evaluation with the receiving operating curve (ROC) excluded eyes with the vertical diameter of the optic nerve > 2.0 and < 1.5. Results: The mean and median SD-OCT RNFL values were: group 1) 62.0±3.3 ?m, 54.0 (49.0; 75.8); group 2) 84.4±1.8 ?m, 85.0 (74.0; 94.0), and group 3) 96.6±2.3 ?m, 97.0 (90.5; 102.0) (p<0.001). The mean of the MD were: group 1) -16.7 dB, group 2) -2.5 dB, and group 3) -1.7 dB (p<0.001). The correlation of the SD-OCT RNFL and the SAP was statistically significant (p<0.0001 and r=0.681). The means of the HVOC were divided in three different vertical optic nerve diameter (VD) ranges (<1.5 mm, 1.51-2.00 mm, and >2.00 mm). Within each nerve diameter range the difference of the HVOC from the different groups was statistically significant. For the structural-functional correlation and for the evaluation of the ROC curves only nerves with a VD of 1.51-2.00 mm were evaluated (120 eyes). The HVOCs were divided into four percentile groups with the following medians in ?m: 925 (298-1,079); 1,162 (1,085-1,271); 1,415 (1,273-1,522); and 1,624 (1,527-1,993). There was a statistically significant difference of the values of the MD in each percentile group between group 1 and 3 (p<0.03), group 1 and 4 (p<0.001), group 2 and 3 (p<0.02), and between group 2 and 4 (p<0.001). In those eyes, the correlation between the HVOC and the SD-OCT RNFL was r =-.64 (p<0.001). The areas under the curve (AUC) of the ROC curve and the 95%CI evaluating the HVOC were: for positive cases with MD < -3 dB = 0.76 (0.64-0.85), MD < -6 dB = 0.77 (0.68-0.87), and MD < -12 dB= 0.79 (0.70-0.89). The ROC curves of the SD-OCT RNFL were compared with the HVOC using the DeLong test. There was no statistically significant difference, for positive cases determined as MD < -12 dB, there was a borderline difference (p=0.06). Conclusions: The HVOC provides a simple numeric parameter obtained from two important hallmarks of the glaucomatous nerve: the vertical length of the cupping and the depth of the cupping. In our study, we found a structural-functional correlation of the HVOC with the MD of the SAP, as well as with the RNFL. The AUCs of the HVOC were comparable with those of the RNFL. The HVOC has a potential to be used as an additional topographic parameter of the structural evaluation of glaucoma.
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    Avaliação da motilidade ocular pré e pós-operatória em pacientes submetidos à cirurgia para implante de drenagem para tratamento do glaucoma: análise de série de casos e revisão de literatura
    (Universidade Federal de São Paulo (UNIFESP), 2016-04-29) Ronconi, Cristiana Soares [UNIFESP]; Prata, Tiago dos Santos [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    OBJECTIVE: To evaluate changes in ocular extrinsic motility and ocular positioning in the primary position of the gaze in the pre and postoperative period of patients submitted to the implantation of drainage devices for the treatment of glaucoma. METHODS: A prospective study was carried out to evaluate extrinsic ocular motility and ocular positioning in the primary position of the eyes of patients who underwent drainage implant surgery to treat glaucoma. Demographic data, previous ophthalmological history, presence of subjective complaints of diplopia in the pre and postoperative period, and investigation of heterotropies and heterophores before and after surgery were analyzed. RESULTS: Of the total of 14 patients studied, eight (57.14%) patients were orthotropic and six (42.85%) had a deviation before surgery. At the end of the follow-up, eight (57.14%) patients had ocular deviation, and four (28.57%) patients maintained the same range of preoperative deviation, two (14.28%) patients presented increased And two (14.28%) patients developed new deviations. The frequency of development / worsening of postoperative deviations was 28.57%. All the patients presented divergent deviation in the pre and postoperative period. The diagnosis of Neovascular glaucoma was a possible predisposing factor for the development of postoperative deviation, since three (75%) of the patients who presented development / worsening of the deviations were diagnosed (versus 33.33% of those who did not present a deviation ). CONCLUSIONS: The incidence of ocular deviations and changes in ocular motility in the postoperative period of patients submitted to the Baerveldt implant - 350 mm2 of this study is within the range presented by previous studies. Differently from most of the published studies, in which the preoperative examination was not performed, this study showed that half of the patients who had a postoperative deviation presented it before surgery. This reinforces the importance of the evaluation of extrinsic ocular motility in the preoperative examination, besides the need for orientation of the patients with indication of this surgery for the treatment of glaucoma regarding the possibility of this adverse effect.
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    Avaliação do dano glaucomatoso por meio de ressonância magnética funcional e correlação com achados psicofísicos e estruturais oculares
    (Universidade Federal de São Paulo (UNIFESP), 2016-11-29) Gerente, Vanessa Miroski [UNIFESP]; Paranhos Junior, Augusto Paranhos Junior [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Purpose: To evaluate the functional magnetic resonance imaging (fMRI) response to binocular visual stimulation and the association thereof with structural ocular findings and psychophysical test results in patients with glaucoma, and controls. Methods: Cross-sectional study. Participants underwent a complete ophthalmic examination, including Humphrey 24-2 visual field (VF) testing and optical coherence tomography. Binocular VF in each quadrant was determined using the best location or IVF method. Patients with glaucoma were assigned to three subgroups: initial, asymmetrical and severe glaucoma. Regions of interest (ROIs) were determined anatomically. fMRI (3T) was performed using a bilaterally presented polar angle stimulus, and the accompanying changes in blood oxygen level-dependent (BOLD) signals were obtained from the occipital poles and calcarine ROIs. We used generalized estimation equation models to compare anatomical and functional data between the groups. Results: A total of 25 subjects were enrolled, of whom 17 had glaucoma and 8 were controls. Significant associations between quadrant binocular VF sensitivities and fMRI responses were found in the occipital pole ROIs (p=0.033) and the calcarine ROIs (p=0.045). In glaucoma severity subgroup analysis, retinal nerve fiber layer (RNFL) thickness was associated with the BOLD response of the calcarine and occipital pole ROIs (p=0.002 and 0.026, respectively). The initial and asymmetrical glaucoma subgroups had similar binocular VF sensitivities and RNFL thicknesses, but distinct BOLD responses. Conclusions: The response of the visual cortex to binocular stimulation was associated with binocular VF sensitivity. RNFL thickness was associated with the BOLD response of the calcarine and occipital pole ROIs in subgroup analysis.
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    Avaliação do dano ocular após queimadura química grave na córnea e suas possíveis implicações no implante da ceratoprótese de boston
    (Universidade Federal de São Paulo (UNIFESP), 2015-12-31) Jorge, Fabiano Cade [UNIFESP]; Siqueira, Wallace Chamon Alves de Siqueira [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    A severe chemical burn to the eye usually results in an opaque cornea. Its prognosis depends on the immediate treatment and prevention of further complications. Regardless of medical efforts, surgical rehabilitation with standard penetrating keratoplasty, often repeated, is usually fruitless in the long run, due to limbal stem cell deficiency. Boston Keratoprosthesis (KPro) is reported to give better outcome. However, in chemical burn eyes, optic nerve and retina seem to become more sensitive, developing intraocular complications, such as glaucoma, even with normal intraocular pressure, and retinal detachment. A retrospective review of patients with KPro and severe chemical burns was performed; the number of eyes with a preoperative history or signs of glaucoma was 21 (75%) out of 28 eyes, nine of which had glaucoma progression after KPro implantation. Thus, anti glaucoma medication must be prescribed, and therefore pressure evaluation must have priority in the early burn follow-up. Protection against optic nerve injury should have importance post burn. In addition, inflammation control plays an important role in this scenario. It has been showed that post burn inflammation results in a cloudy cornea and neovascularization. Retina may also be damaged. Two possible mechanisms of retinal damage after ocular surface burn can be hypothesized: first, direct pH-related alkali diffusion from the anterior chamber to the back of the eye, leading to cell cytotoxicity and retinal injury. And second, diffusion of inflammatory cytokines, especially tumor necrosis alpha (TNF-?) from the site of the injury to the posterior segment, causing cell death and retinal damage. The use of infliximab was tested to block TNF-? in mice. In pilot in-vivo and ex-vivo experiments, using larger eyes form pigs and rabbits, respectively, direct pH measurements revealed that the alkalinity in the anterior chamber was significantly elevated. In contrast, pH measurements in the vitreous remained unchanged, suggesting that prompt alkali diffusion posteriorly through the vitreous is very unlikely. In our model, early retinal damage after ocular surface alkali burns, and the protective effects of TNF-? blockade were evaluated. There was significant damage to the retina by 24 hours after corneal burn. TUNEL positive labeling was present in the retinal ganglion cells. Increase in the retinal inflammatory cytokines levels was showed in burned eyes. A single dose of anti-TNF-? antibody provided substantial retinal and corneal protection. This finding could lead to novel and more efficient therapies for chemical injury patients treatment.
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    Avaliação do disco óptico e da camada de fibras nervosas peripapilar sem midríase: é confiável?
    (Universidade Federal de São Paulo (UNIFESP), 2013-11-27) Colicchio, Daniel [UNIFESP]; Paranhos Junior, Augusto Paranhos Junior [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Objetivo: investigar a taxa de concordância intra-observador e inter-observadores para a avaliação do Disco Óptico (DO) e da camada de fibras nervosas peripapilar (CFN) com e sem midríase. Métodos: estudo prospectivo, em que foram incluídos pacientes glaucomatosos/suspeitos e indivíduos saudáveis. Três especialistas em glaucoma documentaram as características do DO e da CFN de todos os pacientes antes e após midríase de uma maneira mascarada e padronizada. A taxa de concordância intra-observador e inter-observadores para a avaliação do DO e da CFN foi calculada antes e após a midríase. Usando retinografias coloridas estereoscópicas como o “padrão ouro”, também foi comparada a habilidade de cada examinador em identificar sinais sugestivos de dano glaucomatoso do DO e da CFN, com e sem midríase. Resultado: um total de 30 pacientes (60 olhos) foram incluídos (idade média: 62,3±11,6 anos). Após a midríase, considerando a avaliação de todos os examinadores, a estimativa média da 6 relação escavação/disco (E/D) vertical aumentou de 0,41 para 0,44 (p=0,02). E ainda, o desvio-padrão médio e o coeficiente de variabilidade das medidas reduziram significativamente de 0,06 para 0,05 e de 0,24 para 0,11, respectivamente (p≤0,03). O coeficiente Kappa inter-observadores variou de 0,64 até 0,72 antes da midríase e de 0,71 até 0,77 após a midríase. A habilidade dos examinadores em identificar sinais sugestivos de dano glaucomatoso do DO e da CFN aumentou após a midríase para todos os sinais, mas apenas dot sign e disc notching tiveram significância estatística (p≤0,01). Conclusão: Examinadores experientes têm uma tendência em hipoestimar a relação E/D e têm uma habilidade pior em identificar alguns sinais sugestivos de dano glaucomatoso do DO e da CFN quando avaliam pacientes sem midríase. Os resultados sugerem que o exame fundoscópico de pacientes glaucomatosos/suspeitos sem midríase não deve ser recomendado.
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    Betabloqueador tópico pode determinar resultados inconclusivos no ecocardiograma sob estresse com dobutamina em pacientes com glaucoma
    (Sociedade Brasileira de Cardiologia - SBC, 2007-07-01) Cordovil, Adriana [UNIFESP]; Matos, Fernando Q. [UNIFESP]; Campos Filho, Orlando [UNIFESP]; Paranhos Junior, Augusto [UNIFESP]; Rodrigues, Ana Clara T. [UNIFESP]; Albernaz, Márcia V. [UNIFESP]; De Paola, Angelo Amato Vincenzo [UNIFESP]; Carvalho, Antonio Carlos [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Hospital Israelita Albert Einstein; Hospital Sírio-Libanês; Universidade de São Paulo (USP)
    Dobutamine stress echocardiography is a well-established method to assess coronary artery disease, of which sensitivity has been enhanced by adding atropine at the end of the protocol. Individuals with glaucoma, a disease with a high prevalence in patients with cardiac diseases older than 40 years, cannot benefit from the use of atropine as it is contraindicated for this group of patients. Additionally, these individuals are often treated with topical betablockers (eye drops), which can have systemic effects by decreasing cardiac frequency, blood pressure and pulmonary capacity. The aim of our study was to verify whether a possible systemic effect caused by the use of these eye drops, yielding a low chronotropic response, could result in inconclusive dobutamine stress echocardiography in patients with glaucoma.
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    Cataract in early onset and classic Cockayne syndrome
    (Aeolus Press, 1997-12-01) Ferreira, R. C.; Roeder, E. R.; Bateman, J.; Universidade Federal de São Paulo (UNIFESP)
    Purpose: To describe cataracts in classic and early onset Cockayne syndrome (CS). Classic CS typically has an onset after the first year of life; intrauterine growth failure and severe neurologic dysfunction from birth distinguishes the less common early onset cs from the classic form. Methods. A complete ophthalmic evaluation was performed in four affected patients, one with the early onset and three with classic cs. Results. We report cataract in all patients and glaucoma in one, the latter never previously reported in cs. Conclusion: CS should be considered in babies with low birth weight and congenital cataract.
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    Changes in visual function after intraocular pressure reduction using antiglaucoma medications
    (Nature Publishing Group, 2009-05-01) Prata, Tiago dos Santos [UNIFESP]; Piassi, M. V.; Melo, L. A. S.; Universidade Federal de São Paulo (UNIFESP)
    Purpose To evaluate the change in visual function after starting glaucoma treatment and correlate this to a decrease in intraocular pressure (IOP) in primary open-angle glaucoma patients.Methods A prospective, randomized clinical trial was carried out involving 54 glaucoma patients (54 eyes). After inclusion, patients randomly received timolol maleate 0.5%, brimonidine tartrate 0.2%, or travoprost 0.004% in one randomly selected eye. Patients underwent Goldmann applanation tonometry, visual acuity test, standard automated perimetry (SAP), visual quality perception test (visual analogue scale), and contrast sensitivity (CS) test, in a random order before and after the 4-week glaucoma treatment.Results There were statistically significant changes in IOP (mean change [standard deviation], 7.8 [3.6] mmHg, P 0.001), SAP mean deviation index (0.84 [2.45] dB, P = 0.02), visual quality perception (0.56 [1.93], P = 0.045), and CS at frequencies of 12 cycles/degree (0.10 [0.37], P = 0.03) and 18 cycles/degree (0.18 [0.42], P = 0.02) after the 4-week treatment when compared with baseline. No statistically significant differences were found between the treatment groups in visual function changes after treatment (P > 0.40). No significant correlations between IOP reduction and changes in visual function were found (P > 0.30).Conclusions Visual quality perception, visual field mean deviation index, and CS at higher frequencies improve after starting glaucoma therapy. However, no correlation was found between IOP reduction and changes in visual function, and no differences were found in visual function when the three medications studied were compared. Eye (2009) 23, 1081-1085; doi:10.1038/eye.2008.226; published online 1 August 2008
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    Comparison of Different Spectral Domain OCT Scanning Protocols for Diagnosing Preperimetric Glaucoma
    (Assoc Research Vision Ophthalmology Inc, 2013-05-01) Lisboa, Renato [UNIFESP]; Paranhos Junior, Augusto [UNIFESP]; Weinreb, Robert N.; Zangwill, Linda M.; Leite, Mauro Toledo [UNIFESP]; Medeiros, Felipe Andrade [UNIFESP]; Univ Calif San Diego; Universidade Federal de São Paulo (UNIFESP)
    PURPOSE. To compare the ability of spectral-domain optical coherence tomography (SDOCT) retinal nerve fiber layer (RNFL), optic nerve head (ONH), and macular measurements to detect preperimetric glaucomatous damage.METHODS. the study included 142 eyes from 91 patients suspected of having the disease based on the appearance of the optic disc. All eyes had normal visual fields before the imaging session. Forty-eight eyes with progressive glaucomatous damage were included in the preperimetric glaucoma group. Ninety-four eyes without any evidence of progressive glaucomatous damage and followed untreated for 12.8 +/- 3.6 years were used as controls. Areas under the receiver operating characteristic curves (AUC) were calculated to summarize diagnostic accuracies of the parameters.RESULTS. the three RNFL parameters with the largest AUCs were average RNFL thickness (0.89 +/- 0.03), inferior hemisphere average thickness (0.87 +/- 0.03), and inferior quadrant average thickness (0.85 +/- 0.03). the three ONH parameters with the largest AUCs were vertical cup-to-disc ratio (0.74 +/- 0.04), rim area (0.72 +/- 0.05), and rim volume (0.72 +/- 0.05). the three macular parameters with the largest AUCs were GCC average thickness (0.79 +/- 0.04), GCC inferior thickness (0.79 +/- 0.05), and GCC superior thickness (0.76 +/- 0.05). Average RNFL thickness performed better than vertical cup-to-disc ratio (0.89 vs. 0.74; P = 0.007) and GCC average thickness (0.89 vs. 0.79; P = 0.015).CONCLUSIONS. SDOCT RNFL measurements performed better than ONH and macular measurements for detecting preperimetric glaucomatous damage in a cohort of glaucoma suspects.
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    Concentration of hyaluronic acid in primary open-angle glaucoma aqueous humor
    (Elsevier B.V., 2005-06-01) Navajas, E. V.; Martins, JRM; Melo, LAS; Saraiva, V. S.; Dietrich, C. P.; Nader, H. B.; Belfort, R.; Universidade Federal de São Paulo (UNIFESP)
    We compared the concentration of hyaluronic acid in the aqueous humor of primary open-angle glaucoma (POAG) patients and non-glaucomatous patients. Aqueous humor samples were obtained from 22 patients just before trabeculectomy for clinically uncontrolled POAG (POAG group). Aqueous humor (0.1 mL) was aspirated by inserting a 26-gauge needle into the anterior chamber. the same procedure was performed for 22 non-glaucomatous patients just before cataract surgery (control group). Immediately after collection, the aqueous humor was stored at -20 degrees C. the concentration of hyaluronic acid was determined by a sensitive, noncompetitive and nonisotopic fluoroassay. the median (range) concentrations of hyaluronic acid of the POAG and control groups were 298.4 mu g L-1 (99.0-743.7 mu g L-1) and 545.1 mu g L-1 (145.0-2366.0 mu g L-1), respectively. the difference in concentrations of hyaluronic acid between the groups was statistically significant (P < 0.001). in conclusion, the concentration of hyaluronic acid in the aqueous humor in POAG patients is lower than in non-glaucomatous patients. Further studies are necessary to determine the role of hyaluronic acid in the pathophysiology of POAG. (c) 2005 Elsevier B.V. All rights reserved.
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    Factors associated with topographic changes of the optic nerve head induced by acute intraocular pressure reduction in glaucoma patients
    (Nature Publishing Group, 2011-02-01) Prata, Tiago dos Santos [UNIFESP]; Lima, V. C. [UNIFESP]; Moraes, C. G. Vasconcelos de; Guedes, L. M. [UNIFESP]; Magalhaes, F. P. [UNIFESP]; Teixeira, S. H. [UNIFESP]; Ritch, R.; Paranhos, A. [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); New York Eye & Ear Infirm; New York Med Coll
    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. Eye (2011) 25, 201-207; doi:10.1038/eye.2010.179; published online 3 December 2010
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    Hypotensive Effect of Juxtascleral Administration of Anecortave Acetate in Different Types of Glaucoma
    (Lippincott Williams & Wilkins, 2010-09-01) Prata, Tiago Santos [UNIFESP]; Tavares, Ivan Maynart [UNIFESP]; Mello, Paulo Augusto de Arruda [UNIFESP]; Tamura, Caroline [UNIFESP; Lima, Veronica Castro; Belfort, Rubens [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Purpose: To evaluate the intraocular pressure (IOP)-lowering effect of anecortave acetate, delivered by anterior juxtascleral depot injection, in eyes with various forms of glaucoma.Methods: A prospective, interventional case series was carried out. Twenty-eight uncontrolled glaucoma patients received a single injection of anecortave acetate (24 to 30 mg) in 1 selected eye under topical anesthesia. Postinjection assessments were scheduled at week 1 and months 1, 2, and 3.Results: Mean +/- SD age of patients was 58.2 +/- 18.6 years. Twelve patients had open-angle glaucoma and 16 had angle-closure glaucoma. Uveitic/steroid-induced glaucoma was the most frequent diagnosis (11 patients, 39.2%). Mean baseline IOP was 30.7 +/- 9.3mm Hg. Mean IOP at week 1 and months 1, 2, and 3 were 21.3 +/- 6.1, 19.8 +/- 6.3, 20.9 +/- 7.3, and 21.7 +/- 6.8mm Hg, respectively. Significant mean IOP reductions were observed at week 1 and months 1, 2, and 3 (29.3%, 33.8%, 30.1%, and 27.2%, respectively; P < 0.001).Conclusion: A single administration of anecortave acetate by anterior juxtascleral depot injection seems to result in a significant IOP reduction (compared with baseline) for at least 3 months in eyes with different types of glaucoma. No injection-related or drug-related serious adverse events were observed. Additional studies are required to better determine the efficacy, safety, and mechanism of action of this alternative treatment.
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    Influence of pupillary diameter, ciliary muscle tone, and ambient light on nerve fiber layer measurements with scanning laser polarimetry
    (Lippincott Williams & Wilkins, 2005-04-01) Paranhos Junior, Augusto [UNIFESP]; Silvestre, Ana Maria [UNIFESP]; Passerotti, Carlo C. [UNIFESP]; Martins, Elizabeth M. R. [UNIFESP]; Mello, Paulo Augusto de Arruda [UNIFESP]; Prata Junior, João Antonio [UNIFESP]; Shields, M. B; Universidade Federal de São Paulo (UNIFESP); Yale Univ
    Purpose: To evaluate the influence of the pupillary diameter, ciliary muscle tone, and room light on nerve fiber layer measurements with the scanning laser polarimeter (GDx).Methods: One randomly selected eye of ten normal volunteers was examined with the GDx in a two-day protocol under eight testing conditions (pilocarpine 1%, phenylephrine 10%, tropicamide 1%, or no drops with room lights on or off). the twelve parameters, obtained by the GDx, were compared under the eight testing conditions, using two way ANOVA for repeated measurements and Tukey HSD post hoc test.Results: Ten of the twelve parameters were statistically significantly different (P < 0.05) when measured under the three medication or no medication conditions, controlling for the ambient light status. There were no significant differences when measured with the light on or off, controlling for use of drops.Conclusions: Nerve fiber layer measurements with the GDx were influenced by drugs affecting pupillary diameter, but not by the status of room light or ciliary muscle tone.
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    No changes in anatomical and functional glaucoma evaluation after trabeculectomy
    (Springer, 2006-05-01) Tavares, I. M.; Melo, LAS; Prata, J. A.; Galhardo, R.; Paranhos, A.; Mello, PAA; Universidade Federal de São Paulo (UNIFESP); Fed Univ Triangulo Mineiro
    To assess the influence of glaucoma filtration surgery on anatomical and functional tests for glaucoma evaluation.Twenty-five eyes (25 patients) with primary open-angle glaucoma were evaluated, prospectively. Data were collected on vision acuity, intraocular pressure, standard automated perimetry, frequency doubling technology perimetry, scanning laser polarimetry (GDx) and confocal scanning laser ophthalmoscopy (HRT II) before and 3-6 months after surgery.Mean (+/- SD) pre- and postoperative visual acuities (logMAR) were 0.28 (+/- 0.18) and 0.30 (+/- 0.17), respectively (P=0.346). in a mean time of 4.5 (+/- 1.1) months after surgery, the mean preoperative intraocular pressure of 20.7 (+/- 5.4) mmHg decreased to 11.04 (+/- 2.52) mmHg (P < 0.001). the results of the standard automated perimetry, frequency doubling technology perimetry, scanning laser polarimetry and confocal scanning laser ophthalmoscopy diagnostic methods revealed no significant difference (P > 0.162) between pre and postoperative values and no significant correlation (P > 0.296) between intraocular pressure reduction and value changes.No significant change on any test variable was detected after glaucoma filtration surgery. Trabeculectomy does not appear to influence standard automated perimetry, frequency doubling technology perimetry, scanning laser polarimetry and confocal scanning laser ophthalmoscopy (HRT II) results after a 4.5-month period of surgery in early to moderate glaucoma.