Avaliação oftalmológica e vascular em pacientes com glaucoma de ângulo aberto e hemorragia de disco: existem diferenças entre pacientes com hemorragia de disco de pressão intraocular baixa e alta?
Data
2023-11-23
Autores
Almeida, Izabela Negrão Frota de 
Orientadores
Prata, Tiago dos Santos
Tipo
Tese de doutorado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Objetivo: Avaliar diferenças clínicas, oftalmológicas e vasculares de pacientes com glaucoma de ângulo aberto (GAA) e hemorragia de disco (HD) com pressão intraocular (PIO) baixa (low-tension disc hemorrhage, LTDH) e alta (high-tension disc hemorrhage, HTDH). Esse estudo foi dividido em três fases: 1. Avaliar diferenças clínicas e oftalmológicas em pacientes com LTDH e HTDH; 2. Identificar parâmetros vasculares entre esses grupos, através de endotelina-1 (ET-1) sérica, laser Doppler imaging (LDI) das polpas digitais e capilaroscopia periungueal (CP); 3. Avaliar características clínicas e oftalmológicas associadas à presença de escotoma parafoveal (PFS) em pacientes com HD. Métodos: Na primeira fase, os pacientes foram subdivididos em dois grupos, de acordo com a PIO no momento em que a HD foi observada: HTDH (PIO ≥ 16 mmHg) e LTDH (PIO < 16 mmHg). As diferenças clínicas e oftalmológicas entre os grupos foram avaliadas. Na segunda fase, os pacientes foram submetidos à coleta de sangue para análise da ET-1 e aos exames de LDI e CP. Na terceira fase, os pacientes com GAA e HD foram divididos em dois grupos, de acordo com a presença de PFS no campo visual (CV), e as diferenças clínicas e oftalmológicas foram avaliadas. Resultados: 1. Comparados ao grupo de HTDH, os pacientes com LTDH eram mais frequentemente mulheres [77% versus (vs) 42%; p = 0,030], asiáticos (24% vs 9%; p = 0,058), com desregulação vascular (34% vs 14%; p = 0,057), pior índice de desvio médio (MD) de CV (p = 0,037), maior prevalência de glaucoma de pressão normal (GPN) (46% vs 17%; p < 0,001) e tendência a córneas mais finas (p = 0,066). 2. O nível sanguíneo de ET-1 foi 65% maior no grupo com LTDH (2,27 ± 1,46 pg/mL) que naquele com HTDH (1,37 ± 0,57; p = 0,030 pg/mL). Além disso, houve correlação negativa significativa entre a concentração sanguínea de ET-1 e a PIO no momento da detecção de HD (r = -0,45; p = 0,020). A medição do fluxo sanguíneo do grupo com LTDH foi menor do que a do grupo com HTDH tanto 10 minutos (233 ± 109 vs 382 ± 55 unidades arbitrárias de perfusão (PU), respectivamente; p < 0,010) quanto 20 minutos após o estímulo frio (249 ± 116 vs 397 ± 47 PU, respectivamente; p < 0,010). Anormalidades no CP foram documentadas em mais de 80% dos casos em ambos os grupos, sem diferenças entre eles (p = 0,730). 3. O grupo com PFS teve maior prevalência de pacientes caucasianos (82% vs. 47%; p < 0,010). Olhos com PFS tiveram mais equivalente esférico negativo e pior MD (p ≤ 0,010). A análise multivariável, controlando para MD, revelou que apenas raça caucasiana e miopia (como variáveis contínua e categórica) mantiveram-se significativas neste modelo (p ≤ 0,038). Conclusões: Comparados ao grupo com HTDH, os pacientes do grupo com LTDH parecem se enquadrar em um perfil representado por mulheres, asiáticos, com diagnóstico de GPN, maior perda de CV e mais sintomas sugestivos de desregulação vascular; além disso, apresentam níveis sanguíneos de ET-1 mais altos e mais disfunção vascular periférica. A raça caucasiana e a presença de miopia (e sua magnitude) foram associadas com a ocorrência de PFS em olhos glaucomatosos com HD.
Objective: To evaluate clinical, ophthalmological, and vascular differences in patients with open-angle glaucoma (OAG) and disc hemorrhage (DH) with low (low-tension disc hemorrhage, LTDH) and high (high-tension disc hemorrhage, HTDH) intraocular pressure (IOP). This study was divided into three phases: 1. To evaluate clinical and ophthalmological differences in patients with LTDH and HTDH; 2. To identify vascular parameters between these groups, as assessed by endothelin-1 (ET-1) blood level measurements, laser Doppler imaging (LDI) of distal phalanx, and nailfold capillaroscopy (NC); 3. To evaluate clinical and ophthalmological factors associated with the presence of parafoveal scotoma (PFS) in glaucomatous eyes with DH. Methods: In the first phase, patients were subdivided into two groups, according to the IOP at the time DH was observed: HTDH (IOP ≥ 16 mmHg) and LTDH (IOP < 16 mmHg). Clinical and ophthalmological differences between the groups were evaluated. In the second phase, patients underwent blood collection for ET-1 analysis and LDI and CP exams. In the third phase, patients with OAG and DH were divided into two groups according to the presence of PFS in visual field (VF), and clinical and ophthalmological differences were evaluated. Results: 1. Compared to the HTDH group, the patients with LTDH were more often women [77% versus (vs) 42%; p = 0.030], Asian (24% vs 9%; p = 0.058), with vascular dysregulation (34% vs 14%; p = 0.057), worse VF mean deviation (MD) index (p = 0.037), higher prevalence of normaltension glaucoma (NTG) (46% vs 17%; p < 0.001), and tended to have thinner corneas (p = 0.066). 2. The blood level of ET-1 was 65% higher in the LTDH group (2.27 ± 1.46 pg/mL) compared to the HTDH group (1.37 ± 0.57 pg/ml; p = 0.030). In addition, a significant negative correlation was found between ET-1 blood concentration and IOP at the time of DH detection (r = -0.45; p = 0.020). The blood flow measurement values of the LTDH patients were lower than those of the HTDH group both 10 minutes [233 ± 109 vs 382 ± 55 perfusion units (PU), respectively; p < 0.010) and 20 minutes after the cold stimulus (249 ± 116 vs 397 ± 47 PU, respectively; p < 0.010). Abnormalities in NC were documented in over 80% of the cases in both groups, without differences between them (p = 0.730). 3. The PFS group had a higher prevalence of Caucasian patients (82% vs. 47%; p < 0.010). Eyes with PFS had a more negative spherical equivalent and worse MD (p ≤ 0.010). Multivariate analysis, controlling for MD, revealed that only Caucasian race and myopia (as continuous and categorical variables) remained significant in this model (p ≤ 0.038). Conclusions: Compared to the HTDH group, patients in the LTDH group seem to fit into a profile represented by women, Asians, diagnosed with NTG, greater VF loss and more symptoms suggestive of vascular dysregulation; in addition, they have higher blood levels of ET-1 and more peripheral vascular dysfunction. Caucasian race and the presence of myopia (and its magnitude) were associated with the occurrence of PFS in glaucomatous eyes with DH.
Objective: To evaluate clinical, ophthalmological, and vascular differences in patients with open-angle glaucoma (OAG) and disc hemorrhage (DH) with low (low-tension disc hemorrhage, LTDH) and high (high-tension disc hemorrhage, HTDH) intraocular pressure (IOP). This study was divided into three phases: 1. To evaluate clinical and ophthalmological differences in patients with LTDH and HTDH; 2. To identify vascular parameters between these groups, as assessed by endothelin-1 (ET-1) blood level measurements, laser Doppler imaging (LDI) of distal phalanx, and nailfold capillaroscopy (NC); 3. To evaluate clinical and ophthalmological factors associated with the presence of parafoveal scotoma (PFS) in glaucomatous eyes with DH. Methods: In the first phase, patients were subdivided into two groups, according to the IOP at the time DH was observed: HTDH (IOP ≥ 16 mmHg) and LTDH (IOP < 16 mmHg). Clinical and ophthalmological differences between the groups were evaluated. In the second phase, patients underwent blood collection for ET-1 analysis and LDI and CP exams. In the third phase, patients with OAG and DH were divided into two groups according to the presence of PFS in visual field (VF), and clinical and ophthalmological differences were evaluated. Results: 1. Compared to the HTDH group, the patients with LTDH were more often women [77% versus (vs) 42%; p = 0.030], Asian (24% vs 9%; p = 0.058), with vascular dysregulation (34% vs 14%; p = 0.057), worse VF mean deviation (MD) index (p = 0.037), higher prevalence of normaltension glaucoma (NTG) (46% vs 17%; p < 0.001), and tended to have thinner corneas (p = 0.066). 2. The blood level of ET-1 was 65% higher in the LTDH group (2.27 ± 1.46 pg/mL) compared to the HTDH group (1.37 ± 0.57 pg/ml; p = 0.030). In addition, a significant negative correlation was found between ET-1 blood concentration and IOP at the time of DH detection (r = -0.45; p = 0.020). The blood flow measurement values of the LTDH patients were lower than those of the HTDH group both 10 minutes [233 ± 109 vs 382 ± 55 perfusion units (PU), respectively; p < 0.010) and 20 minutes after the cold stimulus (249 ± 116 vs 397 ± 47 PU, respectively; p < 0.010). Abnormalities in NC were documented in over 80% of the cases in both groups, without differences between them (p = 0.730). 3. The PFS group had a higher prevalence of Caucasian patients (82% vs. 47%; p < 0.010). Eyes with PFS had a more negative spherical equivalent and worse MD (p ≤ 0.010). Multivariate analysis, controlling for MD, revealed that only Caucasian race and myopia (as continuous and categorical variables) remained significant in this model (p ≤ 0.038). Conclusions: Compared to the HTDH group, patients in the LTDH group seem to fit into a profile represented by women, Asians, diagnosed with NTG, greater VF loss and more symptoms suggestive of vascular dysregulation; in addition, they have higher blood levels of ET-1 and more peripheral vascular dysfunction. Caucasian race and the presence of myopia (and its magnitude) were associated with the occurrence of PFS in glaucomatous eyes with DH.