Arquivos brasileiros de oftalmologia最新文献

Purpose: This study evaluated macular thickness using spectral-domain optical coherence tomography in healthy participants from a population-based eye survey.

Methods: The Brazilian Amazon Region Eye Survey was a population-based study assessing the prevalence and causes of visual impairment, blindness, and ocular diseases in adults aged ≥45 years from urban and rural areas of Parintins. A subgroup was selected based on inclusion criteria for both eyes: best-corrected visual acuity ≥20/32, normal eye examination results, and no prior ocular surgery. Scans were performed using the iVue optical coherence tomography device. Measurements were taken from the nine subfields defined by the Early Treatment Diabetic Retinopathy Study, examining the full retina as well as the inner and outer retinal layers. Associations of retinal thickness with age and sex were also analyzed. Statistical significance was set at p≤0.05.

Results: In total, 70 healthy participants (25 males), aged 45-65 years (mean=52 ± 5), were included. Mean central foveal thickness was 248.71 ± 18.73 μm. A significant age-related reduction in macular thickness was observed, particularly in the inner superior parafovea (p=0.036), nasal perifovea (p=0.001), superior perifovea (p=0.028), outer layer of inferior parafovea (p=0.049), and the inferior perifovea of the full retina (p=0.029). Males showed significantly greater thickness in the outer layer, especially in the outer parafovea (p=0.004) and perifovea (p<0.0001).

Conclusions: This study established normative macular thickness values for healthy older adults in the Brazilian Amazon region using spectral-domain optical coherence tomography. Age and sex were found to significantly influence macular thickness and should be considered when interpreting measurements. These data will support future studies of retinal diseases in this population.

Angle-closure glaucoma is a major cause of visual impairment worldwide, with Plateau iris syndrome presenting management challenges. We present a case report of a 58-year-old woman with advanced, uncontrolled angle--closure glaucoma and Plateau iris. Her history included laser peripheral iridotomy and three glaucoma medications in both eyes. Different treatments were implemented. For the eye with lower intraocular pressure, fewer peripheral anterior synechiae, and milder disease: phacoemulsification with intraocular lens implantation. For the eye with more advanced disease, a two-step approach was used: slow-coagulation transscleral cyclophotocoagulation using the double-arc protocol, followed by phacoemulsification with intraocular lens implantation 2 months later. Both eyes achieved improved visual acuity and intraocular pressure control with fewer medications, without significant complications. This case highlights transscleral cyclophotocoagulation followed by phacoemulsification as an alternative to combined surgeries in uncontrolled angle-closure glaucoma with Plateau iris, offering a simpler technique, more predictable refractive and pressure-control outcomes, and more straightforward postoperative management.

Purpose: To compare endothelial corneal cell changes following cataract surgery performed by phacoemulsification with intraocular lens implantation, conducted by surgeons with varying levels of experience.

Methods: Two hundred and eighty-three eyes diagnosed with cataract were included. Lens opacity was classified into three categories (I, II, and III). Surgeons were categorized into four experience levels (1, 2, 3, and 4), based on years of practice and lifetime surgeries performed. Corneal endothelial characteristics were assessed using non-contact specular microscopy, with measurements taken before surgery and 30-60 days post-surgery.

Results: Preand postoperative endothelial analysis showed no significant differences between surgeon levels regarding visual acuity achieved, corneal thickness, and endothelial hexagonality. However, the central endothelial cell density index showed a significantly greater reduction among level 1 surgeons (p=0.026). Grade II cataracts exhibited significant variations in the central endothelial cell density (p=0.011) and average cell size, with level 1 surgeons showing the largest increases (p=0.024).

Conclusions: The analysis revealed significant differences in visual acuity and endothelial indices between surgeon experience levels, with less experienced surgeons showing greater variations and poorer performance. Clinical protocols should consider these data to establish safer training protocols.

Myopia is a significant risk factor for glaucoma and a growing public health problem worldwide. Detecting glaucomatous changes in highly myopic eyes is diagnostically challenging due to the abnormal appearance of the optic nerve head. These patients also have a greater biomechanical susceptibility to pressure-induced glaucomatous damage. Refractive surgery has become increasingly popular, and many candidates for refractive surgery are myopic. Therefore, we sought to review the aspects of patient evaluation in those who have undergone refractive surgery for myopia concerned with the detection and monitoring of glaucoma development. We identified several important elements of patient evaluation for glaucoma after refractive surgery. These included the need for both structural and functional assessments before and after surgery, and the importance of monitoring for postoperative biomechanical changes in the cornea and their impact on intraocular pressure. We conclude that, in patients who undergo refractive surgery for myopia, it is essential to assess for the presence of glaucoma, to identify staging, and to plan for long-term control of the disease, regardless of IOP.

Purpose: This pilot study was conducted to investigate the presence of various bioactive compounds (copeptin, asprosin, and salusins) in the blood and tears of patients with glaucoma.

Methods: A total of 83 subjects, including 28 patients with open-angle glaucoma, 28 patients with ocular hypertension, and 27 control volunteers, were enrolled in this study. The levels of salusin-α, salusin-β, copeptin, and asprosin in tears and venous blood samples were measured by enzyme linked immunosorbent assay (ELISA).

Results: Patients with open-angle glaucoma and those with ocular hypertension showed statistically significantly decreased levels of salusin-α and salusin-β in their blood and tears compared with those of control subjects (p<0.05), with the decrease being the most pronounced in patients with ocular hypertension (p<0.05). In contrast, the levels of copeptin and asprosin showed a statistically significant increase in both these patient groups compared with those of control subjects (p<0.05). There was a negative correlation between intraocular pressure and blood and tear salusins.

Conclusions: Fluids from patients with open-angle glaucoma and ocular hypertension showed lower salusin levels. Patients with ocular hypertension had higher levels of copeptin and asprosin, but not those with open-angle glaucoma (except for asprosin, whose levels showed a slight but remarkable increase in plasma in patients with open-angle glaucoma). The pathogenesis of ocular hypertension and open-angle glaucoma may be significantly impacted by these biomarkers.

Purpose: This study evaluated rates of thyroid eye disease-related eyelid surgeries, strabismus surgeries, and orbital decompressions in active thyroid eye disease patients treated with teprotumumab compared to those who were not.

Methods: In this single-center longitudinal study, we compared patients with active thyroid eye disease evaluated from 02/01/2017 to 01/31/2020 (pre-teprotumumab era) with those seen from 02/01/2020 to 04/30/2023 (teprotumumab era). Patients from the pre-teprotumumab era who received corticosteroids and/or orbital radiation were compared with those in the teprotumumab era treated with teprotumumab, with or without corticosteroids and/or orbital radiation. The primary outcomes were rates of orbital decompressions, strabismus surgery, and eyelid surgery among patients with at least 6 months of follow-up. Orbital decompressions involving two or more walls were classified as severe.

Results: Of 486 records reviewed, 106 patients had active thyroid eye disease. Among them, 33 were from the pre-teprotumumab era; 22 received corticosteroids and/or orbital radiation, and 11 received no treatment. Seventy three patients were from the teprotumumab era; 37 received teprotumumab (with or without corticosteroids and/or orbital radiation), 10 received corticosteroids and/or orbital radiation alone, and 26 received no treatment. Demographics were comparable between groups. Orbital decompression was performed in 11 of 44 eyes (25.0%) in the pre-teprotumumab era treated with corticosteroids and/or orbital radiation (8 one-wall, 3 ≥two-wall), compared to 3 of 74 eyes (4.1%) in the teprotumumab era treated with teprotumumab with or without corticosteroids and/or orbital radiation (all one-wall). The overall rate of orbital decompressions and the rate of ≥two-wall decompressions were significantly lower in the teprotumumab era (p=0.02 and p=0.0496, respectively). There was no significant difference in one-wall decompressions between era (p=0.07). Rates of strabismus surgeries (27.3% vs. 13.5%, p=0.19) and eyelid surgeries (22.7% vs. 21.6%, p=0.92) did not significantly differ between the era.

Conclusions: In patients with active thyroid eye disease, treatment with teprotumumab was associated with a significantly lower rate and severity of orbital decompressions compared to treatment with corticosteroids and/or orbital radiation alone. However, the rates of strabismus and eyelid surgeries remained similar between groups.

Purpose: This study aimed to evaluate the influence of intrastromal corneal ring segment implants on the intraocular pressure measurements using Goldmann applanation tonometry, rebound tonometry, and noncontact tonometry in keratoconic corneas and analyze the intertonometer agreement.

Methods: We enrolled 74 eyes in this observational and prospective study. Each participant had a complete eye examination, corneal analysis with Scheimpflug Tomography (Pentacam®), and intraocular pressure evaluation with Goldmann applanation tonometry, rebound tonometry, and noncontact tonometry, before and after intrastromal corneal ring segment implantation (on postoperative days 1, 7, 45, and 90). Intertonometer agreement was assessed using Bland-Altman analysis.

Results: The mean age was 29.9 ± 10.2 years, and 47 (63.5%) eyes had keratoconus grade II. Intraocular pressures were higher for noncontact tonometry preoperatively and on 90 postoperative day (mean ± SD: 12.4 ± 2.2 and 12.1 ± 2.2 mmHg, respectively), followed by Goldmann applanation tonometry (11.1 ± 3.0 and 11.2 ± 2.7 mmHg, respectively), and were lower for rebound tonometry (9.7 ± 3.4 and 9.4 ± 3.2 mmHg, respectively). The variation from the Goldmann tonometry on 7 postoperative day to the baseline (p=0.022) and that of noncontact tonometry on 90 postoperative day to the baseline (p=0.021) were statistically significant. The rebound tonometry underestimated intraocular pressure when compared with the Goldmann applanation tonometry by a mean of 1.47 ± 5.19 mmHg. Noncontact tonometry, when compared with Goldmann applanation tonometry, overestimated intraocular pressure by a mean of 1.23 ± 4.15 mmHg.

Conclusion: Despite statistically significant differences between some postoperative periods, the intraocular pressure measurement differences may not be clinically relevant.