RESUMEN

PURPOSE: The interplay between myopia and glaucoma has gained attention, with escalating myopia demonstrating a significant association with increased POAG rates, particularly in patients with severe myopia. This systematic review aimed to comprehensively analyze the relationship between myopia and glaucoma, focusing on the structural and functional implications, risk factors, and assessment modalities. Optical coherence tomography (OCT) played a crucial role in this study, particularly in highly myopic populations. METHODS: This study's rigor is underscored by using the PRISMA guidelines, which ensured a meticulous search strategy was employed across multiple databases from 2012 to 2024. The inclusion criteria included individuals aged 18 years or older with high myopia, defined as a spherical equivalent of less than -6.0 diopters or an axial length > 26.0 mm, diagnosed with chronic glaucoma. Various study designs were incorporated, including randomized controlled trials, prospective cohort studies, and observational studies. Quality assessment was performed using the Jadad Scale, and statistical analyses were performed to summarize the study characteristics and outcomes. RESULTS: Of the 350 initial articles, 15 met the inclusion criteria. OCT assessments revealed structural changes such as thinning of the retinal nerve fiber layer preceding functional losses. Meta-analyses demonstrated a heightened risk of POAG with increasing myopia severity, showing a significant nonlinear relationship. This meta-analysis of six studies involving 3040 patients revealed a relationship between myopia and glaucoma (OR = 12.0, 95% CI 10.1-4.7, P < 0.00001). CONCLUSION: This comprehensive analysis consolidates the evidence of the relationship between myopia and glaucoma, emphasizing the pivotal role of OCT and other imaging modalities in early detection and monitoring.

---

Glaucoma is a significant cause of permanent blindness worldwide. This causes damage to the visual nerve that worsens over time. The primary way to treat open-angle glaucoma and its many causes is to lower eye pressure. Further research is being conducted to determine the relationship between nearsightedness and glaucoma. Increased nearsightedness is significantly linked to higher rates of glaucoma, especially in people with severe nearsightedness. This review aimed to examine the link between myopia and glaucoma in greater depth, focusing on structural and functional effects, risk factors, and assessment methods, especially optical coherence tomography (OCT), in very nearsighted people. We conducted a thorough search of several databases between 2012 and 2024. Individuals aged 18 years or older with myopia greater than six diopters or an axial length greater than 26 mm and a diagnosis of chronic glaucoma were eligible. Randomized controlled trials, prospective cohort studies, and observational studies were some of the methods used in this study. The quality of the work and statistical methods were used to summarize the features and results of the study. Of the 350 articles initially published, only 15 met the inclusion criteria. These studies mostly used different optical tomography tests to detect structural changes, such as ocular nerve fiber layer damage, before functional loss. According to meta-analyses, the risk of chronic glaucoma increases as myopia worsens, indicating a solid nonlinear relationship. Myopia and glaucoma are linked, demonstrating the importance of thorough evaluation. Severe myopia is strongly associated with damage to the visual nerve. Over the past few years, optical tomography has become a vital imaging tool for identifying early damage to the optic nerve. However, further research is needed on the sex-related tendencies of glaucoma patients. This study provides data that reveal a link between nearsightedness and glaucoma, highlighting the importance of optical tomography and other imaging techniques for early detection and monitoring. To better manage glaucoma in highly myopic individuals, we need to understand how the severity of myopia, changes in structure, and changes in function affect each other.

Asunto(s)

Glaucoma , Miopía , Células Ganglionares de la Retina , Tomografía de Coherencia Óptica , Humanos , Glaucoma/fisiopatología , Glaucoma/diagnóstico , Glaucoma/complicaciones , Presión Intraocular/fisiología , Miopía/diagnóstico , Miopía/fisiopatología , Miopía/complicaciones , Fibras Nerviosas/patología , Disco Óptico/diagnóstico por imagen , Disco Óptico/patología , Células Ganglionares de la Retina/patología , Factores de Riesgo , Tomografía de Coherencia Óptica/métodos , Campos Visuales/fisiología

RESUMEN

PURPOSE: To evaluate the predictive value of initial intraocular pressure difference of the detached and fellow eyes of patients with complex rhegmatogenous retinal detachment on postoperative persistent ocular hypotony. METHODS: This retrospective observational study included 538 eyes of 538 unilateral complex rhegmatogenous retinal detachment patients with a proliferative vitreoretinopathy grade of C-1 or higher, treated with silicone oil endotamponade following pars plana vitrectomy. The patients were divided into Group A (patients having silicone oil removal without ocular hypotony; n=504) and Group B (patients with persistent ocular hypotony following silicone oil removal [n=8, 23.5%] and with retained silicone oil [n=26, 76.5%] due to the risk of persistent ocular hypotony; total n=34). Ocular hypotony was defined as an intraocular pressure of <6 mmHg on two or more occasions. Patients' demographics, including age, sex, and follow-up time, and ocular characteristics, including ocular surgical and trauma history, initial and final best-corrected visual acuity, intraocular pressure and initial intraocular pressure difference of the detached and fellow eyes, and anatomical success rates and postoperative complications, were retrospectively collected from the electronic patient files. RESULTS: The initial intraocular pressure was significantly lower in the detached eyes of Group B than in Group A (8.3 ± 3.5 vs. 12.9 ± 3.3, p<0.001). Also, the initial intraocular pressure difference was significantly higher in Group B than in Group A (8.9 ± 3.2 vs. 2.2 ± 2.7mmHg, p<0.001). The receiver operating characteristic curve analysis showed that the cutoff value of the initial intraocular pressure difference was 7.5mmHg for the risk of persistent ocular hypotony. The most influential factors on postoperative persistent ocular hypotony in the binary logistic regression analysis were the initial intraocular pressure difference and the need for a retinectomy. CONCLUSION: In eyes with complex rhegmatogenous retinal detachment treated with pars plana vitrectomy and silicone oil tamponade, the initial intraocular pressure difference could be of value in predicting postoperative persistent ocular hypotony and could guide surgeons on the decision of silicone oil removal.

Asunto(s)

Presión Intraocular , Hipotensión Ocular , Desprendimiento de Retina , Aceites de Silicona , Agudeza Visual , Vitrectomía , Humanos , Desprendimiento de Retina/cirugía , Vitrectomía/efectos adversos , Vitrectomía/métodos , Hipotensión Ocular/etiología , Hipotensión Ocular/fisiopatología , Femenino , Masculino , Estudios Retrospectivos , Presión Intraocular/fisiología , Persona de Mediana Edad , Adulto , Anciano , Agudeza Visual/fisiología , Factores de Riesgo , Resultado del Tratamiento , Complicaciones Posoperatorias/etiología , Adulto Joven , Vitreorretinopatía Proliferativa/cirugía , Vitreorretinopatía Proliferativa/fisiopatología , Vitreorretinopatía Proliferativa/etiología , Valor Predictivo de las Pruebas , Endotaponamiento , Factores de Tiempo , Valores de Referencia

RESUMEN

INTRODUCTION: The aim of the study was to evaluate the macular thickness of glaucomatous patients undergoing trabeculectomy (TREC) with mitomycin C (MMC) with or without the use of prostaglandin analog (PA) eye drops. METHODS: In this prospective, comparative clinical trial, patients with glaucoma and indications for TREC with MMC using PA and without previous macular changes were randomized into 2 groups: the study group (SG) and the control group (CG). In the CG, PA was suspended between 30 and 60 days after the preoperative exams. The subjects were evaluated, including optical coherence tomography (OCT) with the Cirrus 4000 macular protocol preoperatively and in the postoperative period on 3 occasions: 1-3 days ("PO1"), 6-9 days ("PO7"), and 27-30 days ("PO30") after surgery. The results were compared between groups. RESULTS: Thirty-five eyes of 35 patients were included (17 in the CG and 18 in the SG). There was no statistically significant difference in age (p = 0.2), the preoperative visual field mean deviation (p = 0.08), or the preoperative intraocular pressure (SG: 24.8 ± 7.8 mm Hg vs. CG: 22.8 ± 6.0 mm Hg, p = 0.4). The preoperative macular OCT parameters were equivalent between the groups (p > 0.05). When comparing the variation of parameters between the groups between preop and PO30 there was equivalence in all of the comparisons evaluated. The presence (or absence) of the lens did not affect the results. CONCLUSION: PA eye drops did not affect macular thickness after TREC with MMC in glaucomatous patients.

Asunto(s)

Glaucoma , Presión Intraocular , Mácula Lútea , Mitomicina , Soluciones Oftálmicas , Tomografía de Coherencia Óptica , Trabeculectomía , Humanos , Trabeculectomía/métodos , Estudios Prospectivos , Mitomicina/administración & dosificación , Masculino , Femenino , Tomografía de Coherencia Óptica/métodos , Persona de Mediana Edad , Presión Intraocular/fisiología , Glaucoma/cirugía , Glaucoma/fisiopatología , Glaucoma/diagnóstico , Mácula Lútea/patología , Mácula Lútea/diagnóstico por imagen , Anciano , Prostaglandinas Sintéticas/administración & dosificación , Prostaglandinas Sintéticas/uso terapéutico , Agudeza Visual , Alquilantes/administración & dosificación , Adulto

RESUMEN

PURPOSE: This study investigated the relationship between blood pressure and intraocular pressure in treatmentnaive, non-glaucoma patients with different blood pressure statuses, focusing on the 24-h ocular volume and nocturnal blood pressure decline. METHODS: Treatment-naive, non-glaucoma patients undergoing hypertension evaluation were enrolled as study participants. Simultaneous 24-h ambulatory blood pressure measurement and 24-h ocular volume recording with a contact lens sensor. We also compared ocular volume curve parameters between normotensive and hypertensive patients, as well as between those with and without nocturnal blood pressure decline. RESULTS: A total of 21 patients, including 7 normotensive and 14 treatment-naive hypertensive individuals, were included in the study. of them, 11 were dippers and 10 were non-dippers. No significant difference in the 24-h ocular volume slope was observed between the hypertensive and normotensive patients (p=0.284). However, dippers had a significantly higher 24-h ocular volume slope (p=0.004) and nocturnal contact lens sensor output (p=0.041) than non-dippers. CONCLUSION: Nocturnal blood pressure decline, rather than the blood pressure level, is associated with the increased 24-h ocular volume slope and nocturnal ocular volume. Further studies are required to determine whether the acceleration of glaucoma progression in dippers is primarily due to low blood pressure, high intraocular pressure, or a combination of both.

Asunto(s)

Monitoreo Ambulatorio de la Presión Arterial , Presión Sanguínea , Ritmo Circadiano , Hipertensión , Presión Intraocular , Humanos , Presión Intraocular/fisiología , Masculino , Femenino , Presión Sanguínea/fisiología , Ritmo Circadiano/fisiología , Persona de Mediana Edad , Monitoreo Ambulatorio de la Presión Arterial/métodos , Hipertensión/fisiopatología , Adulto , Factores de Tiempo , Tonometría Ocular/métodos , Valores de Referencia , Estudios de Casos y Controles

RESUMEN

PURPOSE: This study aimed to determine whether early-stage intraocular pressure can be modulated using a thermal face mask. METHODS: In this prospective clinical study, healthy participants were randomized on a 1:1:1 allocation ratio to three mask groups: hypothermic (G1), normothermic (G2), and hyperthermic (G3). After randomization, 108 eyes from 108 participants were submitted to clinical evaluations, including measurement of initial intraocular pressure (T1). The thermal mask was then applied for 10 minutes, followed by a second evaluation of intraocular pressure (T2) and assessment of any side effects. RESULTS: The hypothermic group (G1) showed a significant reduction in mean intraocular pressure between T1 (16.97 ± 2.59 mmHg) and T2 (14.97 ± 2.44 mmHg) (p<0.001). G2 showed no significant pressure difference between T1 (16.50 ± 2.55 mmHg) and T2 (17.00 ± 2.29 mmHg) (p=0.054). G3 showed a significant increase in pressure from T1 (16.53 ± 2.69 mmHg) to T2 (18.58 ± 2.95 mmHg) (p<0.001). At T1, there was no difference between the three study groups (p=0.823), but at T2, the mean values of G3 were significantly higher than those of G1 and G2 (p<0.00). CONCLUSION: Temperature was shown to significantly modify intraocular pressure. Thermal masks allow the application of temperature in a controlled, reproducible manner. Further studies are needed to assess the duration of these effects and whether they are reproducible in patients with pathologies that affect intraocular pressure.

Asunto(s)

Presión Intraocular , Humanos , Presión Intraocular/fisiología , Estudios Prospectivos , Masculino , Femenino , Adulto , Adulto Joven , Tonometría Ocular/métodos , Tonometría Ocular/instrumentación , Factores de Tiempo , Máscaras , Valores de Referencia , Hipotermia Inducida/métodos , Persona de Mediana Edad , Reproducibilidad de los Resultados , Hipertermia Inducida/métodos

RESUMEN

PURPOSE: This study aimed to compare the safety and effectiveness of intraocular pressure reduction between micropulse transscleral cyclophotocoagulation and "slow cook" transscleral cyclophotocoagulation in patients with refractory primary open-angle glaucoma. METHODS: We included patients with primary open angle glaucoma with at least 12 months of follow-up. We collected and analyzed data on the preoperative characteristics and postoperative outcomes. The primary outcomes were a reduction of ≥20% of the baseline value (criterion A) and/or intraocular pressure between 6 and 21 mmHg (criterion B). RESULTS: We included 128 eyes with primary open-angle glaucoma. The preoperative mean intraocular pressure was 25.53 ± 6.40 and 35.02 ± 12.57 mmHg in the micropulse- and "slow cook" transscleral cyclophotocoagulation groups, respectively (p<0.001). The mean intraocular pressure was reduced significantly to 14.33 ± 3.40 and 15.37 ± 5.85 mmHg in the micropulse- and "slow cook" transscleral cyclophotocoagulation groups at the last follow-up, respectively (p=0.110). The mean intraocular pressure reduction at 12 months was 11.20 ± 11.46 and 19.65 ± 13.22 mmHg in the micropulse- and "slow cook" transscleral cyclophotocoagulation groups, respectively (p<0.001). The median preoperative logMAR visual acuity was 0.52 ± 0.69 and 1.75 ± 1.04 in the micropulse- and "slow cook" transscleral cyclophotocoagulation groups, respectively (p<0.001). The mean visual acuity variation was -0.10 ± 0.35 and -0.074 ± 0.16 in the micropulse- and "slow cook" transscleral cyclophotocoagulation, respectively (p=0.510). Preoperatively, the mean eye drops were 3.44 ± 1.38 and 2.89 ± 0.68 drugs in the micropulse- and "slow cook" transscleral cyclophotocoagulation groups, respectively (p=0.017), but those were 2.06 ± 1.42 and 1.02 ± 1.46 at the end of the study in the "slow cook" and micropulse transscleral cyclophotocoagulation groups, respectively (p<0.001). The success of criterion A was not significant between both groups. Compared with 11 eyes (17.74%) in the "slow cook" transscleral cyclophotocoagulation group, 19 eyes (28.78%) in the micropulse transscleral cyclophotocoagulation group showed complete success (p=0.171). For criterion B, 28 (42.42%) and 2 eyes (3.22%) showed complete success after micropulse- and "slow cook" transscleral cyclophotocoagulation, respectively (p<0.001). CONCLUSION: Both techniques reduced intraocular pressure effectively.

Asunto(s)

Glaucoma de Ángulo Abierto , Presión Intraocular , Coagulación con Láser , Láseres de Semiconductores , Esclerótica , Humanos , Glaucoma de Ángulo Abierto/cirugía , Glaucoma de Ángulo Abierto/fisiopatología , Presión Intraocular/fisiología , Femenino , Masculino , Persona de Mediana Edad , Resultado del Tratamiento , Coagulación con Láser/métodos , Anciano , Láseres de Semiconductores/uso terapéutico , Esclerótica/cirugía , Agudeza Visual , Adulto , Estudios de Seguimiento , Periodo Posoperatorio , Cuerpo Ciliar/cirugía , Factores de Tiempo

RESUMEN

Glaucoma, the leading cause of irreversible blindness worldwide, is a neurodegenerative disease characterized by chronic axonal damages and progressive loss of retinal ganglion cells, with increased intraocular pressure (IOP) as the primary risk factor. While current treatments focus solely on reducing IOP, understanding glaucoma through experimental models is essential for developing new therapeutic strategies and biomarkers for early diagnosis. Our research group developed an ocular hypertension rat model based on limbal plexus cautery, which provides significant glaucomatous neurodegeneration up to four weeks after injury. We evaluated long-term morphological, functional, and vascular alterations in this model. Our results showed that transient ocular hypertension, lasting approximately one week, can lead to progressive increase in optic nerve cupping and retinal ganglion cells loss. Remarkably, the pressure insult caused several vascular changes, such as arteriolar and venular thinning, and permanent choroidal vascular swelling. This study provides evidence of the longitudinal effects of a pressure insult on retinal structure and function using clinical modalities and techniques. The multifactorial changes reported in this model resemble the complex retinal ganglion cell degeneration found in glaucoma patients, and therefore may also provide a unique tool for the development of novel interventions to either halt or slow down disease progression.

Asunto(s)

Modelos Animales de Enfermedad , Glaucoma , Presión Intraocular , Células Ganglionares de la Retina , Animales , Ratas , Glaucoma/fisiopatología , Glaucoma/patología , Células Ganglionares de la Retina/patología , Presión Intraocular/fisiología , Vasos Retinianos/patología , Vasos Retinianos/fisiopatología , Hipertensión Ocular/fisiopatología , Hipertensión Ocular/patología , Ratas Sprague-Dawley

RESUMEN

PURPOSE: To evaluate the stability of the postoperative vault of the implantable phakic contact lens (IPCL) 5 years after implantation. SETTING: Clínica de Ojos Dr. Nano, Olivos, Buenos Aires, Argentina. DESIGN: Retrospective case-series study. METHODS: Myopic patients operated with the IPCL for spherical correction in which preoperative data were compared with different scenarios of postoperative vault at 1, 3, and 5 years postoperatively. The main parameter to be evaluated was the vault obtained 5 years postoperatively. RESULTS: 140 eyes of 72 patients, aged 31.9 ± 2.8 years (21 to 50), were included. Most of the eyes (78.6%) obtained a vault between 250 µm and 750 µm, while in 15% of the eyes, it was less than 250 µm, and 6.4% were greater than 750 µm. The vault evaluated 1, 3, and 5 years postoperatively remained stable. Subcapsular cataracts were detected in 2 eyes, with vault <250 µm. A total of 50 eyes (35.7%) had cysts in the sulcus (5 cases in the group of eyes with vault >750 µm). No changes were detected in relation to intraocular pressure or endothelial cell count. CONCLUSIONS: In eyes implanted with the IPCL over 5 years, it was observed that the vault remained stable over time. The proportion of eyes with cysts was higher in eyes with vaults larger than 750 µm.

Asunto(s)

Miopía , Lentes Intraoculares Fáquicas , Agudeza Visual , Humanos , Estudios Retrospectivos , Adulto , Miopía/cirugía , Miopía/fisiopatología , Persona de Mediana Edad , Adulto Joven , Agudeza Visual/fisiología , Femenino , Masculino , Estudios de Seguimiento , Refracción Ocular/fisiología , Presión Intraocular/fisiología , Periodo Posoperatorio , Implantación de Lentes Intraoculares

RESUMEN

This article discusses treatment options for suspects of primary angle-closure disease.

Asunto(s)

Glaucoma de Ángulo Cerrado , Presión Intraocular , Humanos , Glaucoma de Ángulo Cerrado/diagnóstico , Glaucoma de Ángulo Cerrado/fisiopatología , Presión Intraocular/fisiología , Antihipertensivos/uso terapéutico

RESUMEN

PURPOSE: To compare the safety and efficacy of micropulse laser (MP-TSCP) and slow coagulation transscleral cyclophotocoagulation (TSCP) with a diode laser for reducing intraocular pressure (IOP) in patients with refractory childhood glaucoma (CG). METHODS: Patients with CG and at least 12 months of medical chart data were included. Data on preoperative and postoperative outcomes were analyzed. The primary outcomes were an IOP of 6-21 mmHg and/or ≥ 20% reduction in the baseline value. RESULTS: A total of 17 eyes were included. The preoperative mean IOP was 28 mmHg in the MP-TSCP and 29.9 mmHg in the TSCP. The mean IOP decreased significantly to 17.26 ± 3.27 mmHg in the MP-TSCP and 14.68 ± 5.79 mmHg TSCP at the last medical record. Three anti-glaucoma meds were administered to the eyes preoperatively in both groups. A mean of 1.02 eye drops was administered to the MP-TSCP and 2.06 to the TSCP. The number of medications decreased by 2.38 ± 1.55 in the MP-TSCP and 0.82 ± 1.68 in the TSCP. The median preoperative visual acuity (logMAR) was 1.51 ± 1.06 in the MP-TSCP and 1.87 ± 0.74 in the TSCP. The variation in mean visual acuity (logMAR) was -0.027 ± 0.05 in the MP-TSCP and -0.40 ± 0.58 in the TSCP. The most frequent complication was corneal decompensation (one - MP-TSCP and two - TSCP). CONCLUSION: Both techniques were effective and relatively safe for reducing IOP. These techniques appear to extend the indications of cyclophotocoagulation in CG eyes and improve the functional prognosis.

Asunto(s)

Cuerpo Ciliar , Glaucoma , Presión Intraocular , Coagulación con Láser , Láseres de Semiconductores , Esclerótica , Agudeza Visual , Humanos , Presión Intraocular/fisiología , Coagulación con Láser/métodos , Masculino , Femenino , Agudeza Visual/fisiología , Niño , Esclerótica/cirugía , Glaucoma/cirugía , Glaucoma/fisiopatología , Cuerpo Ciliar/cirugía , Estudios Retrospectivos , Láseres de Semiconductores/uso terapéutico , Preescolar , Resultado del Tratamiento , Adolescente , Tonometría Ocular , Estudios de Seguimiento

RESUMEN

PRCIS: Selective laser trabeculoplasty can be used as a substitute for medications in patients with mild-to-moderate glaucoma, reducing the cost of eye drop distribution in the Brazilian public health system. PURPOSE: To observe the effectiveness of selective laser trabeculoplasty (SLT) as a substitute for eye drops in patients with open angle glaucoma in the Brazilian Public Health System. MATERIALS AND METHODS: SLT was performed bilaterally after medication washout. This is a prospective interventional study comparing intraocular pressure (IOP) when using eye drops at baseline (post-washout), and at 12-month follow-up after SLT. Medication was added if the target IOP was not achieved, following the Brazilian Public Health System eye drops protocol, based on medication costs. Absolute (without eye drops) and qualified (with eye drops) success were measured with IOP ≤ 21, IOP ≤ 18, IOP ≤ 15 and IOP ≤ 12 mm Hg. Besides IOP evolution, the ability to reduce IOP (in %), and eye drops reduction were evaluated. RESULTS: Ninety-two eyes of 46 patients were included, 70 eyes with mild glaucoma and 22 with moderate glaucoma; the mean number of eye drops was 2.26±1.06 (82.6% were using a prostaglandin analogue), and post-washout IOP of 21.10±5.24 mm Hg. There was relative success at IOP ≤18 mm Hg, where the mild group had greater success than the moderate group (88.1% vs. 71.4%, P =0.824). The average IOP reductions were 23.04% and 25.74% at 6 and 12 months, respectively. The average number of eye drops was 1.02, with 1.1% using a prostaglandin analogue. Furthermore, 68.19% of the patients had a decrease in the quantity of eye drops used. CONCLUSION: SLT is effective in reducing IOP and replacing eye drops in patients in the Brazilian Public Health System. Moreover, there was a significant reduction in the use of prostaglandin analogues.

Asunto(s)

Antihipertensivos , Glaucoma de Ángulo Abierto , Presión Intraocular , Terapia por Láser , Soluciones Oftálmicas , Tonometría Ocular , Trabeculectomía , Humanos , Trabeculectomía/métodos , Presión Intraocular/fisiología , Estudios Prospectivos , Femenino , Glaucoma de Ángulo Abierto/cirugía , Glaucoma de Ángulo Abierto/fisiopatología , Glaucoma de Ángulo Abierto/tratamiento farmacológico , Masculino , Terapia por Láser/métodos , Brasil , Anciano , Persona de Mediana Edad , Antihipertensivos/administración & dosificación , Antihipertensivos/uso terapéutico , Resultado del Tratamiento , Programas Nacionales de Salud

Asunto(s)

Humanos , Humor Acuoso/metabolismo , Malla Trabecular/fisiopatología , Malla Trabecular/metabolismo , Glaucoma/fisiopatología , Glaucoma/metabolismo , Hipertensión Ocular/fisiopatología , Matriz Extracelular/metabolismo , Presión Intraocular/fisiología , Malla Trabecular/cirugía , Glaucoma/terapia , Implantes de Drenaje de Glaucoma

RESUMEN

PURPOSE: To investigate the effect of systemic arterial blood pressure (BP) on rates of progressive structural damage over time in glaucoma. DESIGN: Retrospective cohort study. PARTICIPANTS: A total of 7501 eyes of 3976 subjects with glaucoma or suspected of glaucoma followed over time from the Duke Glaucoma Registry. METHODS: Linear mixed models were used to investigate the effects of BP on the rates of retinal nerve fiber layer (RNFL) loss from spectral-domain OCT (SD-OCT) over time. Models were adjusted for intraocular pressure (IOP), gender, race, diagnosis, central corneal thickness (CCT), follow-up time, and baseline disease severity. MAIN OUTCOME MEASURE: Effect of mean arterial pressure (MAP), systolic arterial pressure (SAP), and diastolic arterial pressure (DAP) on rates of RNFL loss over time. RESULTS: A total of 157 291 BP visits, 45 408 IOP visits, and 30 238 SD-OCT visits were included. Mean rate of RNFL change was -0.70 µm/year (95% confidence interval, -0.72 to -0.67 µm/year). In univariable models, MAP, SAP, and DAP during follow-up were not significantly associated with rates of RNFL loss. However, when adjusted for mean IOP during follow-up, each 10 mmHg reduction in mean MAP (-0.06 µm/year; P = 0.007) and mean DAP (-0.08 µm/year; P < 0.001) but not SAP (-0.01 µm/year; P = 0.355) was associated with significantly faster rates of RNFL thickness change over time. The effect of the arterial pressure metrics remained significant after additional adjustment for baseline age, diagnosis, sex, race, follow-up time, disease severity, and corneal thickness. CONCLUSIONS: When adjusted for IOP, lower MAP and DAP during follow-up were significantly associated with faster rates of RNFL loss, suggesting that levels of systemic BP may be a significant factor in glaucoma progression.

Asunto(s)

Presión Sanguínea/fisiología , Glaucoma/diagnóstico , Glaucoma/fisiopatología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Presión Arterial/fisiología , Progresión de la Enfermedad , Femenino , Estudios de Seguimiento , Humanos , Presión Intraocular/fisiología , Masculino , Persona de Mediana Edad , Fibras Nerviosas/patología , Hipertensión Ocular/fisiopatología , Sistema de Registros , Células Ganglionares de la Retina/patología , Estudios Retrospectivos , Tomografía de Coherencia Óptica , Tonometría Ocular

RESUMEN

ABSTRACT Purpose To evaluate the cost-utility of the iStent inject® for the treatment of mild-to-moderate open-angle glaucoma (OAG) within the Brazilian Unified Health System (SUS). Methods A Markov model was developed, in which the effectiveness outcome measure was the incremental cost-effectiveness ratio (ICER: R$ / QALY quality-adjusted life-year). Direct medical costs were obtained from the SUS perspective. The base case comprised of a hypothetical cohort of patients with OAG using topical medication and being managed according to the Clinical Protocol and Therapeutic Guidelines (PCDT) and a real-world setting based on data from Datasus. The model's robustness through sensitivity analyses was tested. Results In the PCDT base case setting, the trabecular micro-bypass implant provided gains of 0.47 QALYs and an ICER of R$7,996.66/QALY compared to treatment with topical medication. In the real-world setting based on data from Datasus, the trabecular micro-bypass implant, provided gains of 0.47 QALYs and an ICER of R$4,485.68/QALY compared to treatment with topical medication. The results were robust to sensitivity analyses. Conclusion Incorporating iStent inject® to SUS provides an improvement in the patient's quality of life with an additional cost that warrants the benefit provided to patients. Results may be considered cost-effective compared to topical medication.

---

RESUMO Objetivo Avaliar a relação custo-utilidade do iStent inject® para o tratamento do glaucoma de ângulo aberto leve a moderado no Sistema Único de Saúde. Métodos Foi desenvolvido um modelo de Markov, no qual a medida de resultado de efetividade foi a razão custo-efetividade incremental (razão de custo-efetividade incremental: R$/ano de vida ajustado pela qualidade). Os custos médicos diretos foram obtidos por meio da perspectiva do Sistema Único de Saúde. O caso base foi composto de uma coorte hipotética de pacientes com glaucoma de ângulo aberto em uso de medicação tópica tratados de acordo com o Protocolo Clínico e Diretrizes Terapêuticas e um cenário do mundo real baseado em dados do Departamento de Informática do Sistema Único de Saúde. Foi testada a robustez do modelo por meio de análises de sensibilidade. Resultados No cenário base do Protocolo Clínico e Diretrizes Terapêuticas, o implante trabecular micro-bypass proporcionou ganhos de 0,47 ano de vida ajustado pela qualidade e razão de custo-efetividade incremental de R$7.996,66/ano de vida ajustado pela qualidade em relação ao tratamento com medicação tópica. No cenário real baseado em dados do Departamento de Informática do Sistema Único de Saúde, o implante trabecular proporcionou ganhos de 0,47 ano de vida ajustado pela qualidade e razão de custo-efetividade incremental de R$ 4.485,68/ano de vida ajustado pela qualidade em relação ao tratamento com medicação tópica. Os resultados foram robustos para análises de sensibilidade. Conclusão A incorporação do iStent inject® ao Sistema Único de Saúde proporciona melhora na qualidade de vida do paciente com um custo adicional que garante o benefício proporcionado a eles. Os resultados podem ser considerados custo-efetivos em comparação com a medicação tópica.

Asunto(s)

Humanos , Masculino , Femenino , Persona de Mediana Edad , Sistema Único de Salud , Stents/economía , Glaucoma de Ángulo Abierto/cirugía , Glaucoma de Ángulo Abierto/economía , Análisis Costo-Beneficio , Costos y Análisis de Costo , Trabeculectomía/economía , Campos Visuales/fisiología , Cadenas de Markov , Costos de la Atención en Salud , Años de Vida Ajustados por Calidad de Vida , Recursos en Salud/economía , Recursos en Salud/estadística & datos numéricos , Presión Intraocular/fisiología

RESUMEN

ABSTRACT Glaucoma drainage devices are important therapeutic options for cases of refractory glaucoma, in which trabeculectomy with antimetabolites has shown high risk of failure. There are devices with different sizes, designs and materials, and several studies have been conducted to test their safety and effectiveness. Despite known complications, their use has progressively increased in recent years, and they are the primary surgical option, in some situations. The aim of this review is to discuss the importance, mechanisms, biomaterials, results and complications of glaucoma drainage devices.

---

RESUMO Os dispositivos de drenagem para glaucoma são importante opção terapêutica em casos de glaucomas refratários, nos quais a trabeculectomia com antimetabólitos tem alta chance de falência. Há dispositivos com diferentes tamanhos, desenhos e materiais, e muitos estudos foram realizados para testar sua segurança e eficácia. Apesar de suas conhecidas complicações, seu uso tem aumentado progressivamente nos últimos anos, inclusive como primeira opção cirúrgica, em algumas situações. O objetivo desta revisão foi discutir a importância, os mecanismos, os biomateriais, os resultados e as complicações dos dispositivos de drenagem para glaucoma.

Asunto(s)

Humanos , Glaucoma/cirugía , Cirugía Filtrante/instrumentación , Implantes de Drenaje de Glaucoma , Materiales Biocompatibles , Glaucoma/fisiopatología , Cirugía Filtrante/métodos , Implantación de Prótesis , Presión Intraocular/fisiología

RESUMEN

ABSTRACT The purpose of this study was to highlight the impact of biomechanical corneal response in available in vivo tonometry methods for glaucoma management. Systematic review of non-contact air-puff tonometers that analyzes the corneal deformation response, with special focus on the investigation of the correlation of derived parameters with intraocular pressure measurements. The two actual and commercially available in vivo corneal tonometers provide promising information about biomechanical characteristics of the cornea and its relation to glaucoma, allowing the development of new protocols to evaluate, diagnose, and manage this disease.

---

RESUMO O objetivo deste estudo é destacar o impacto da resposta biomecânica corneana em métodos de tonometria in vivo disponíveis para o manejo do glaucoma. Trata-se de revisão sistemática de tonômetros de ar que analisa a resposta à deformação corneana, com foco especial na investigação da correlação dos parâmetros derivados com as medições da pressão intraocular. Os dois tonômetros mais recentes e comercialmente disponíveis fornecem informações promissoras sobre as características biomecânicas da córnea e sua relação com o glaucoma, permitindo o desenvolvimento de novos protocolos para avaliar, diagnosticar e controlar a doença.

Asunto(s)

Humanos , Tonometría Ocular/instrumentación , Tonometría Ocular/métodos , Fenómenos Biomecánicos , Córnea/anatomía & histología , Córnea/fisiología , Presión Intraocular/fisiología , Glaucoma/fisiopatología , Hipertensión Ocular/fisiopatología , Técnicas de Diagnóstico Oftalmológico/instrumentación , Elasticidad/fisiología , Modelos Teóricos

Asunto(s)

Glaucoma/cirugía , Implantes de Drenaje de Glaucoma/economía , Implantes de Drenaje de Glaucoma/tendencias , Diseño de Prótesis , Implantes de Drenaje de Glaucoma/efectos adversos , Presión Intraocular/fisiología

RESUMEN

Introducción: la extracción del cristalino transparente en pacientes con cierre angular primario se plantea si existe presión intraocular mayor o igual que 30 mm Hg o daño por glaucoma. En ojos con elevación moderada de la presión intraocular se desconocen los resultados. Objetivo: evaluar la influencia de la presión intraocular preoperatoria en el control del cierre angular primario tratado con extracción del cristalino transparente. Material y Métodos: se realizó un estudio pre-experimental, entre enero de 2013 y enero de 2020, incluyó 78 ojos de 78 pacientes con cierre angular primario tratados con extracción del cristalino transparente; divididos en dos grupos según presión intraocular preoperatoria. Para el análisis estadístico se empleó chi cuadrado de independencia, probabilidad exacta de Fisher, prueba t para muestras independientes y análisis de varianza de medidas repetidas; con significación estadística del 95 por ciento. Resultados: hubo diferencias significativas entre ambos grupos para longitud axial (p=0,003), grosor del cristalino (p<0,001) y espesor corneal central (p=0,016). La presión intraocular y número de colirios, variaron de forma muy significativa (p<0,001) entre el pre y posoperatorio, y entre ambos grupos en los diferentes momentos analizados. En el grupo A el 94,4 por ciento de los ojos mostró control absoluto posoperatorio invariable en el tiempo, en el grupo B la mayoría de los ojos tuvo control relativo con diferencias muy significativas (p<0,001) entre ambos. Conclusiones: la presión intraocular preoperatoria influye en el control del cierre angular primario tratado con extracción del cristalino transparente; valores previos menores que 30 mm Hg, propician mejor control posoperatorio(AU)

---

Introduction: Clear lens extraction is considered in patients older than 50 years with primary angle closure and intraocular pressure greater than or equal to 30 mm Hg or damage due to glaucoma. The results are unknown in eyes with a moderate elevation of intraocular pressure. Objective: To evaluate the influence of preoperative intraocular pressure in the control of the primary angle closure treated with clear lens extraction. Material and Methods: A pre-experimental study was conducted between January 2013 and January 2020. It included a total of 78 eyes of 78 patients with primary angle closure treated with clear lens extraction. They were divided into two groups according to preoperative intraocular pressure. For statistical analysis, Chi-square test, Fisher's exact probability test, and t test were used for independent samples and analysis of variance with repeated measurements; with 95 percent statistical significance. Results: There were significant differences in axial length (p=0,003), lens thickness (p<0,001) and central corneal thickness (p=0,016) between both groups. Intraocular pressure and the number of eye drops varied very significantly (p<0,001) between the pre-and postoperative periods and between both groups at the different moments analyzed. In group A, 94,4 percent of the eyes showed absolute postoperative control, which remained unchanged over time. In group B, most eyes had relative control. There were very significant differences (p<0,001) between both groups. Conclusions: Preoperative intraocular pressure influences the control of primary angle closure treated with clear lens extraction; previous values less than 30 mm Hg favor better postoperative control(AU)

Asunto(s)

Humanos , Masculino , Femenino , Glaucoma/prevención & control , Presión Intraocular , Presión Intraocular/fisiología , Cristalino , Periodo Posoperatorio

RESUMEN

OBJECTIVE: To describe ocular anatomical features and to determine tear production and tonometry in normal anesthetized ring-tailed coati (Nasua nasua). ANIMALS: Eight male and seven female ring-tailed coatis (30 eyes) were evaluated, with ages ranging from 7 months to 10 years old. PROCEDURES: The animals were anesthetized with isoflurane and had STT 1, rebound and applanation tonometry, and palpebral fissure length (PFL) measured in both eyes. Rebound tonometry was measured with both TonoVet® and TonoVet Plus®. All eyes were evaluated with slit-lamp biomicroscopy. Following pharmacological mydriasis, direct fundoscopy was performed. ANOVA and Tukey tests were used for the data analysis. RESULTS: There were upper and lower eyelids, as well as a third eyelid. Eyelashes were present on the upper eyelid, while meibomian glands openings were visible on both. The bulbar conjunctiva was pigmented. The pupil was obliquely horizontally ovoid and teardrop shaped when miotic. The color of the iris and tapetum lucidum varied with age. The optic disk was round, and the retina was holangiotic. The mean ± standard deviation values obtained were as follows: STT: 2.50 ± 2.39 mm/min; rebound tonometry: 9.50 ± 2.43 mmHg (TonoVet®, calibration P), 14.60 ± 2.82 mmHg (TonoVet®, calibration D), 18.93 ± 3.99 mmHg (TonoVet Plus®, calibration dog); applanation tonometry: 18.66 ± 4.16 mmHg; PFL: 10.98 ± 1.67 mm. CONCLUSIONS AND CLINICAL RELEVANCE: Anatomical and clinical ophthalmic data presented in this study are unprecedented for this species. The results can be used as clinical reference parameters, allowing for better care of these species. The lack of data for the Procyonidae family must be regarded as an incentive for more studies.

Asunto(s)

Presión Intraocular/fisiología , Procyonidae/anatomía & histología , Lágrimas/fisiología , Tonometría Ocular/veterinaria , Animales , Femenino , Masculino , Valores de Referencia

RESUMEN

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.

Asunto(s)

Técnicas de Diagnóstico Oftalmológico , Agua Potable/administración & dosificación , Glaucoma de Ángulo Abierto/fisiopatología , Presión Intraocular/fisiología , Anciano , Humor Acuoso/fisiología , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Tonometría Ocular/métodos