RESUMO

Glaucoma, cataracts, and cognitive decline are most common in older ages. Although cross-sectional studies showed that these disorders are associated, follow-up studies are lacking. To investigate this issue, baseline and follow-up data from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) were employed. We evaluated participants ≥ 55 years-old at follow-up without diagnosis of dementia, stroke, and other eye conditions except for glaucoma and cataracts. Cognition was evaluated using delayed word recall, verbal fluency, and trail making (version B) tests. Regression models were employed to investigate associations between glaucoma and cognition, adjusted by several confounders. Out of 3,867 participants, 379 and 118 presented cataracts and glaucoma, respectively. Only glaucoma was apredictor of lower verbal fluency (B = -0.23, 95% CI -035 to -012, p< 0.001). Other associations were not significant (ps>0.57). Our results suggest that glaucoma may be related to declining cognition.

Assuntos

Catarata , Glaucoma , Idoso , Cognição , Estudos Transversais , Seguimentos , Humanos , Estudos Longitudinais , Pessoa de Meia-Idade , Testes Neuropsicológicos

RESUMO

BACKGROUND: Posterior segment eye diseases, such as glaucoma and retinal diseases (such as diabetic retinopathy, age-related macular degeneration, and retinal detachment), are chronic diseases that are among the major causes of visual impairment. OBJECTIVE: We investigated the prevalence of anxiety disorders, depressive disorders, and common mental disorders in these patients and also the incidence of depression. METHODS: We examined baseline (2008-2010) and follow-up (2012-2014) data from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). We used the Clinical Interview Schedule-Revised (CIS-R) to perform International Classification of Diseases-10-based diagnoses of anxiety and depressive disorders. Common mental disorder was defined as a Clinical Interview Schedule-Revised >11. We used multinomial logistic regression models to investigate associations between eye diseases and mental disorders, adjusted by age, gender, educational level, self-reported ethnicity, cardiovascular conditions, and self-reported quality of vision. RESULTS: Out of 10,775 subjects, 249 (2.3%), 303 (2.8%), and 30 (0.3%) reported having retinal diseases, glaucoma, or both, respectively. Patients with retinal diseases and those with glaucoma and retinal diseases presented a higher prevalence of common mental disorders (relative-risk ratios of 1.7 and 3.7, respectively, P < 0.001). These patients also presented a higher incidence of depression at follow-up (relative-risk ratios of 3.0 and 5.9, respectively, P < 0.001). Patients with glaucoma presented neither a higher prevalence nor a higher incidence of mental disorders or depression. CONCLUSIONS: Retinal diseases but not glaucoma were associated with mental disorders, indicating that patients with posterior segment eye diseases require distinct management of psychiatric morbidity according to the underlying pathology.

Assuntos

Glaucoma , Transtornos Mentais , Adulto , Estudos Transversais , Depressão/epidemiologia , Glaucoma/epidemiologia , Humanos , Modelos Logísticos , Estudos Longitudinais , Transtornos Mentais/epidemiologia

RESUMO

Purpose: To investigate the impact of obstructive sleep apnea (OSA) on the contribution of inner and outer retinal photoreceptors to the pupillary light response (PLR). Methods: Ninety-three eyes from 27 patients with OSA and 25 healthy controls were tested. OSA severity was graded according to the apnea-hypopnea index. PLR was measured monocularly with an eye tracker in a Ganzfeld in response to 1-second blue (470 nm) and red (640 nm) flashes at -3, -2, -1, 0, 1, 2, and 2.4 log cd/m2. Peak pupil constriction amplitude, peak latency, and the postillumination pupil response were measured. The Cambridge Colour Test, standard automatic perimetry, spectral domain optical coherence tomography, polysomnography, and the Pittsburgh Sleep Quality Index were used. Results: OSA patients have a significantly decreased peak pupil constriction amplitude for blue stimuli at -3, -2, -1, 1 log cd/m2 and at all red flash luminances (P < 0.050), revealing reduction of outer retina contributions to PLR. OSA patients showed reduced peak latency for blue (-2, 0, 2, 2.4 log cd/m2) and red stimuli (-2, 0 log cd/m2; P < 0.040). No significant difference was found in the melanopsin-mediated PLR. Conclusions: This study is the first to evaluate the inner and outer retinal contributions to PLR in OSA patients. The results showed that the outer retinal photoreceptor contributions to PLR were affected in moderate and severe OSA patients. In contrast, the inner retina contributions to PLR are preserved.

Assuntos

Pupila/fisiologia , Células Ganglionares da Retina/metabolismo , Opsinas de Bastonetes/metabolismo , Apneia Obstrutiva do Sono/fisiopatologia , Sono/fisiologia , Adulto , Idoso , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estimulação Luminosa , Polissonografia , Células Fotorreceptoras Retinianas Cones/metabolismo , Células Fotorreceptoras Retinianas Cones/patologia , Células Ganglionares da Retina/patologia , Células Fotorreceptoras Retinianas Bastonetes/metabolismo , Células Fotorreceptoras Retinianas Bastonetes/patologia , Tomografia de Coerência Óptica

RESUMO

Connexin (Cx) channels and hemichannels are involved in essential processes during nervous system development such as apoptosis, propagation of spontaneous activity and interkinetic nuclear movement. In the first part of this study, we extensively characterized Cx gene and protein expression during retinal histogenesis. We observed distinct spatio-temporal patterns among studied Cx and an overriding, ubiquitous presence of Cx45 in progenitor cells. The role of Cx-mediated communication was assessed by using broad-spectrum (carbenoxolone, CBX) and Cx36/Cx50 channel-specific (quinine) blockers. In vivo application of CBX, but not quinine, caused remarkable reduction in retinal thickness, suggesting changes in cell proliferation/apoptosis ratio. Indeed, we observed a decreased number of mitotic cells in CBX-injected retinas, with no significant changes in the expression of PCNA, a marker for cells in proliferative state. Taken together, our results pointed a pivotal role of Cx45 in the developing retina. Moreover, this study revealed that Cx-mediated communication is essential in retinal histogenesis, particularly in the control of cell proliferation.

Assuntos

Comunicação Celular/fisiologia , Proliferação de Células , Conexinas/metabolismo , Retina/crescimento & desenvolvimento , Retina/fisiologia , Animais , Carbenoxolona/farmacologia , Comunicação Celular/efeitos dos fármacos , Comunicação Celular/genética , Proliferação de Células/efeitos dos fármacos , Fármacos do Sistema Nervoso Central/farmacologia , Conexinas/antagonistas & inibidores , Conexinas/genética , Regulação da Expressão Gênica no Desenvolvimento/efeitos dos fármacos , Vias Neurais/efeitos dos fármacos , Vias Neurais/crescimento & desenvolvimento , Vias Neurais/fisiologia , Neuroglia/efeitos dos fármacos , Neuroglia/fisiologia , Antígeno Nuclear de Célula em Proliferação/metabolismo , Quinina/farmacologia , Ratos , Ratos Wistar , Retina/efeitos dos fármacos , Células Horizontais da Retina/efeitos dos fármacos , Células Horizontais da Retina/fisiologia , Células-Tronco/efeitos dos fármacos , Células-Tronco/fisiologia , Fatores de Tempo

RESUMO

INTRODUCTION: The objective of this work is to describe a conservative surgical technique as an alternative to classic penile amputations, aiming the local control of the disease, in addition to trying to preserve the patient's sexual function. SURGICAL TECHNIQUE: After a circular incision of the skin around the penis, the subfascial plane is developed until the base of the organ. The dorsal neurovascular bundle and the urethra are isolated in their distal extremities. The neurovascular bundle is sectioned distally. A retrocoronal dissection plane is developed between the glans and the corpora cavernosa. When this stage is complete, the glans is fixed only to the urethra, which is distally sectioned as well. The neurovascular bundle is fixed to the dorsal albuginea. Following the spatulation of the urethra, a neomeatus is created using the overlay skin of the penis. Between January 2001 and July 2002, we employed this technique in 6 patients who had epidermoid carcinoma of the penis, which were limited to the glans, superficial, well or moderately differentiated and measuring up to 3 cm. COMMENTS: Several conservative surgical methods for treatment of carcinoma of the penis aim the organ's preservation, in an attempt of improving the quality of life of patients, however the indexes of local recurrence and failure in disease control are significant. The described technique showed to be safe and effective for disease control, in addition to preserving sexual function in all patients who were treated, representing, thus, a quite appealing conservative surgical alternative in selected cases.

RESUMO

INTRODUCTION: The objective of this work is to describe a conservative surgical technique as an alternative to classic penile amputations, aiming the local control of the disease, in addition to trying to preserve the patient's sexual function. SURGICAL TECHNIQUE: After a circular incision of the skin around the penis, the subfascial plane is developed until the base of the organ. The dorsal neurovascular bundle and the urethra are isolated in their distal extremities. The neurovascular bundle is sectioned distally. A retrocoronal dissection plane is developed between the glans and the corpora cavernosa. When this stage is complete, the glans is fixed only to the urethra, which is distally sectioned as well. The neurovascular bundle is fixed to the dorsal albuginea. Following the spatulation of the urethra, a neomeatus is created using the overlay skin of the penis. Between January 2001 and July 2002, we employed this technique in 6 patients who had epidermoid carcinoma of the penis, which were limited to the glans, superficial, well or moderately differentiated and measuring up to 3 cm. COMMENTS: Several conservative surgical methods for treatment of carcinoma of the penis aim the organ's preservation, in an attempt of improving the quality of life of patients, however the indexes of local recurrence and failure in disease control are significant. The described technique showed to be safe and effective for disease control, in addition to preserving sexual function in all patients who were treated, representing, thus, a quite appealing conservative surgical alternative in selected cases.