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Selective laser trabeculoplasty (SLT) has been used for treatment of primary open-angle glaucoma, ocular hypertension, pigmenter and pseudoexfoliative glaucoma being considered a low-risk procedure. Therefore, transitory and permanent adverse effects have been reported, including corneal changes, subclinical edema, and reduction in endothelial cells and in central corneal thickness. Despite rarer, serious corneal complications after SLT can be permanent and lead to visual impairment, central corneal haze, opacity and narrowing. The mechanism involves increase of vasoactive and chemotactic cytokines causing inflammatory infiltrate, destruction of stromal collagen by fibroblasts and increase of matrix metalloproteinases type 2, which impair reepithelization. SLT also increases free radical production and reduces antioxidant enzymes, resulting in endothelium damages. Low-power laser therapy (LPLT) has been used in regenerative medicine based on its biostimulatory and anti-inflammatory effects. Biostimulation occurs through the interaction of laser photons with cytochrome C oxidase enzyme, which activates intracellular biochemical cascades causing synthesis of a number of molecules related to anti-inflammatory, regenerative effects, pain relief and reduction in edema. It has been showed that LPLT reduces gene expression related to pro-inflammatory cytokines and matrix metalloproteinases, and it increases expression of growth factors related to its proliferative and healing actions. Although radiations emitted by low-power lasers are considered safe and able to induce therapeutic effects, researches based on experimental models for glaucoma could bring important data if LPLT could be an alternative approach to improve acceptation for patients undergoing SLT.

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PURPOSE: To present a new methodology for investigating predictive factors associated with development of vision-related disability in glaucoma. DESIGN: Prospective, observational cohort study. PARTICIPANTS: Two hundred thirty-six patients with glaucoma followed up for an average of 4.3±1.5 years. METHODS: Vision-related disability was assessed by the 25-item National Eye Institute Visual Function Questionnaire (NEI VFQ-25) at baseline and at the end of follow-up. A latent transition analysis model was used to categorize NEI VFQ-25 results and to estimate the probability of developing vision-related disability during follow-up. Patients were tested with standard automated perimetry (SAP) at 6-month intervals, and evaluation of rates of visual field change was performed using mean sensitivity (MS) of the integrated binocular visual field. Baseline disease severity, rate of visual field loss, and duration of follow-up were investigated as predictive factors for development of disability during follow-up. MAIN OUTCOME MEASURES: The relationship between baseline and rates of visual field deterioration and the probability of vision-related disability developing during follow-up. RESULTS: At baseline, 67 of 236 (28%) glaucoma patients were classified as disabled based on NEI VFQ-25 results, whereas 169 (72%) were classified as nondisabled. Patients classified as nondisabled at baseline had 14.2% probability of disability developing during follow-up. Rates of visual field loss as estimated by integrated binocular MS were almost 4 times faster for those in whom disability developed versus those in whom it did not (-0.78±1.00 dB/year vs. -0.20±0.47 dB/year, respectively; P < 0.001). In the multivariate model, each 1-dB lower baseline binocular MS was associated with 34% higher odds of disability developing over time (odds ratio [OR], 1.34; 95% confidence interval [CI], 1.06-1.70; P = 0.013). In addition, each 0.5-dB/year faster rate of loss of binocular MS during follow-up was associated with a more than 3.5 times increase in the risk of disability developing (OR, 3.58; 95% CI, 1.56-8.23; P = 0.003). CONCLUSIONS: A new methodology for classification and analysis of change in patient-reported quality-of-life outcomes allowed construction of models for predicting vision-related disability in glaucoma.

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La pérdida visual causa un enorme sufrimiento tanto para aquellos que la padecen como para sus familiares. Cerca del 80 por ciento de la ceguera es evitable (prevenible o curable). Por tales razones se presentan cuatro casos atendidos durante varios años en la consulta de baja visión del Hospital General Universitario Gustavo Aldereguía Lima de Cienfuegos, por ser pacientes clasificados con una diversidad funcional secundaria a diferentes entidades oftalmológicas: hipermetropía elevada, miopía elevada, glaucoma crónico simple en estadio 4 y afaquia no corregida. Se empleó la técnica quirúrgica de extracción extracapsular con implante de lente intraocular, en uno de ellos Piggy Back primario; en todos los casos hubo resultados satisfactorios en diversos parámetros como agudeza visual, campo visual y disminución del defecto refractivo, por lo que se logró mejorar la calidad de vida de los pacientes, así como su inclusión social y escolar(AU)

Visual loss causes enormous suffering to both the patients and their families. About 80 percent of blindness is avoidable (preventable or curable). Therefore, we present four cases treated for several years in the low vision consultation of the Gustavo Aldereguía Lima University General Hospital of Cienfuegos due to a functional diversity secondary to various ophthalmologic conditions including high hyperopia, high myopia, chronic simple glaucoma at stage 4 and uncorrected aphakia. An extracapsular extraction with intraocular lens implantation was performed, using a primary Piggyback in one of them. All cases showed satisfactory results in various parameters such as visual acuity, visual field and reduced refractive error; thus, it was possible to improve the quality of life of these patients as well as their social and school inclusion(AU)

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Se realizó un estudio descriptivo y longitudinal de 53 pacientes de 0-19 años de edad, con glaucoma del desarrollo, operados mediante trabeculectomía en el Servicio de Oftalmología del Hospital Infantil Sur de Santiago de Cuba desde 1999 hasta 2010, para lo cual se determinaron las características generales del diagnóstico, tratamiento quirúrgico y seguimiento médico integral, este último nunca inferior a un lustro después de la intervención. Se tomaron en cuenta desde los primeros síntomas referidos hasta la rehabilitación óptica y se compararon los resultados de la técnica en todos los integrantes de la casuística, de donde se derivó que fue efectiva en 69,0 por ciento de ellos. También se proporcionan otros datos clínicos y sobre la atención brindada a los niños y adolescentes que padecían la enfermedad(AU)

A descriptive and longitudinal study of 53 patients aged between 0 and 19 years old with growth glaucoma surgically treated through trabeculectomy at Ophthalmology Service from the Southern Children Hospital in Santiago de Cuba was carried out from 1999 to 2010. General characteristics of diagnosis, surgical treatment, and comprehensive follow-up were determined. The latter was never lower than a lustrum after the intervention. First symptoms referred to optical rehabilitation were taken into account. Results of this technique applied in all the members of the case material were compared, from which it was derived that this technique was effective in 69,0 percent of them. Furthermore, other clinical data as well as some related to the health care offered to children and teenagers undergoing this sickness are provided(AU)

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Se realizó un estudio descriptivo y longitudinal de 53 pacientes de 0-19 años de edad, con glaucoma del desarrollo, operados mediante trabeculectomía en el Servicio de Oftalmología del Hospital Infantil Sur de Santiago de Cuba desde 1999 hasta 2010, para lo cual se determinaron las características generales del diagnóstico, tratamiento quirúrgico y seguimiento médico integral, este último nunca inferior a un lustro después de la intervención. Se tomaron en cuenta desde los primeros síntomas referidos hasta la rehabilitación óptica y se compararon los resultados de la técnica en todos los integrantes de la casuística, de donde se derivó que fue efectiva en 69,0 por ciento de ellos. También se proporcionan otros datos clínicos y sobre la atención brindada a los niños y adolescentes que padecían la enfermedad.

A descriptive and longitudinal study of 53 patients aged between 0 and 19 years old with growth glaucoma surgically treated through trabeculectomy at Ophthalmology Service from the Southern Children Hospital in Santiago de Cuba was carried out from 1999 to 2010. General characteristics of diagnosis, surgical treatment, and comprehensive follow-up were determined. The latter was never lower than a lustrum after the intervention. First symptoms referred to optical rehabilitation were taken into account. Results of this technique applied in all the members of the case material were compared, from which it was derived that this technique was effective in 69,0 percent of them. Furthermore, other clinical data as well as some related to the health care offered to children and teenagers undergoing this sickness are provided.

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Se realizó un estudio transversal descriptivo de los pacientes glaucomatosos con baja visión que acudieron a la consulta de Oftalmología del hospital provincial docente “Manuel Ascunce Domenech“ en el período de enero de 1999 a junio de 2002. La muestra fue de 15 pacientes; predominó en ellos el grupo etáreo de 70 a 79 años, el sexo masculino y la raza negra. La lectoescritura fue el principal objetivo que nos propusimos. La agudeza visual de cerca en todos estuvo por debajo de 0,3 (el mayor número entre 0,63 a 0,125). Al rehabilitarse 10 ojos derechos y 11 ojos izquierdos alcanzaron una agudeza visual de 0,4 o más, 11 pacientes se rehabilitaron de acuerdo al objetivo planteado(AU)

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O objetivo deste estudo foi avaliar a influência dos variáveis sexo, raça, técnica de dissecaçäo da conjuntiva (base límbica ou fórnice) idade e nível da pressäo ocular pré-operatória no prognóstico das trabeculectomias, realizadas em pacientes portadores de glaucoma primário do adulto considerando diferentes níveis de pressäo no pós-operatório. Os resultados das trabeculectomias realizadas em 93 olhos de 72 pacientes foram analisados, verificou-se que a taxa de sucesso obtida foi de 86,0 por cento, quando considerou como critério para sucesso cirúrgico pressäo ocular menor ou igual a 21 mmHg; por outro lado, a taxa de sucesso obtida foi de 55,9 por cento quando se considerou como critério para sucesso pressäo ocular pós-operatória menor ou igual a 15 mmHg.

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Com o objetivo de verificar quais as formas de tratamento do glaucoma que podem evitar picos de pressäo e garantir níveis médios de pressäo intra-ocular (PIO) mais baixos, estudamos pacientes submetidos à trabeculoplastia e apenas ao uso de medicaçäo hipotensora ocular. A PIO foi avaliada pelo prova de sobrecarga hídrica. Encontramos uma diminuiçäo significativa da PIO nos três grupos de pacientes após o tratamento, sendo maior no grupo da trabeculectomia em comparaçäo aos outros dois grupos. Este grupo também teve na prova de sobrecarga hídrica (com) menor elevaçäo pressórica, sugerindo ser esta modalidade de tratamento a mais eficaz em evitar picos pressóricos em olhos supostamente bem controlados com o tratamento instituido

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Este trabalho relata o caso de uma paciente de 70 anos com um fibrohistiocitoma maligno da regiäo inferior da órbita, totalmente removido através de uma orbitotomia anterior. Revisamos a literatura enfatizando a raridade deste tumor. Discutimos os principais diagnósticos diferenciais e a conduta frente a este tipo de afecçäo

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O autor faz uma revisäo sobre a incidência da cegueira na idade infantil, destacando os principais causadores desta deficiência no Brasil e, salientando a necessidade da prevençäo da mesma

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Revisan los últimos avances en diferentes áreas de la oftalmología, exponiendo la ventajas y las limitaciones de los métodos disgnósticos y terapéuticos en uso en la especialidad. El autor analiza los adelantos en la medición de la refracción ocular, lentes de contacto, estudio y tratamiento del glaucoma, cataratas y patología de retina, abordaje quirúrgico para corrección de las condiciones de refracción del ojo, microcirugía y aparición de nuevos instrumentos basados en el ultrasonido, radiología, láser y resonancia nuclear magnética, dando una amplia visión sobre el desarrollo de elevada tecnología experimentado últimamente en la oftalmología clínica

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