Simulated cup/disc ratio: a tool for ophthalmologists / Razão escavação/disco simulada: uma ferramenta para oftalmologistas

PURPOSE: To evaluate and compare the observers' ability to measure simulations of cup/disc ratios (CDR) as concentric and non-concentric circles. METHODS: In a prospective, random, and masked setting, 43 images representing the CDR spectrum from 0.2 to 0.9 for vertical and horizontal CDR measurements were developed and presented on a computer screen to 171 participants. RESULTS: There were satisfactory agreements according to the kappa coefficient (0.755 and 0.730 for horizontal and vertical cup disc ratios, respectively) and Lin's concordance correlation (R=0.88 and R=0.86 for horizontal and vertical measurements, respectively). However, very poor agreement was found for intermediate CDR values. The worst agreement occurred when the CDR was between 0.4 and 0.6 for both the horizontal and vertical values. The kappa coefficient was 0.37 and 0.39 for 0.4 CDR (horizontal and vertical, respectively), 0.39 and 0.38 for 0.5 CDR (horizontal and vertical, respectively) and 0.45 and 0.41 for 0.6 CDR (horizontal and vertical, respectively). CONCLUSION: Despite a good general agreement between the gold standard and the participants' responses, the absolute agreement for intermediate CDR values was very poor for both horizontal and vertical values.

OBJETIVO: Avaliar e comparar a habilidade de observadores em medir a razão escavação/disco (CDR) por meio de figuras esquemáticas. MÉTODOS: Em um estudo prospectivo, randomizado e mascarado, 43 imagens representado CDR horizontais e verticais entre 0,2 e 0,9 foram desenvolvidas e apresentadas em uma tela de computador para 171 participantes. RESULTADOS: Para todos os intervalos de CDR a concordância foi satisfatória para análise kappa (0,755 e 0,730 para CDR horizontais e verticais, respectivamente) e para concordância de Lin (R=0,88 e R=0,86 para medidas horizontais e verticais respectivamente). No entanto, a concordância foi fraca para valores intermediários de CDR. A pior concordância ocorreu para CDR horizontais e verticais entre 0,4 e 0,6. CONCLUSÃO: Apesar da boa concordância geral entre as respostas corretas e as respostas dadas pelos participantes, a concordância absoluta para valores intermediários de CDR mostrou-se muito fraca tanto para figuras horizontais como verticais.

Glaucoma in a suburban tertiary care hospital in Nigeria

To determine the incidence and contribution of different types of glaucoma to blindness at Irrua Specialist Teaching Hospital, a suburban tertiary care hospital in Edo State, Nigeria. Medical records of all new patients with glaucoma who presented to the eye clinic of the hospital from June 2007 to May 2009 were reviewed. Out of a total of 2,742 new patients seen over the study period, 177 [6.5%] subjects had glaucoma which included primary open angle glaucoma [130 cases, 73.4%], juvenile glaucoma [31 patients, 17.5%], secondary glaucoma [10 subjects, 5.6%], congenital glaucoma [3 cases, 1.7%] and primary angle closure glaucoma [3 persons, 1.7%]. Of patients with primary open angle glaucoma, 23 [17.7%] were blind based on visual acuity criteria and 67 [51.5%] were blind based on visual field criteria. Glaucoma remains a blinding scourge; late presentation, especially in rural areas, is an important factor predisposing to blindness. In this Nigerian population primary open angle glaucoma was the most prevalent subtype of the disease but primary angle closure glaucoma was rare

Avaliação oftalmológica em pacientes submetidos a implante de drenagem em glaucomas refratários / Ophthalmologic evaluation of patients submitted to drainage implant in refractory glaucoma

Objetivo: Avaliar aspectos pré e pós-operatórios em pacientes submetidosa implantes de drenagem. Métodos: Foi realizado estudo retrospectivo, com pacientes submetidos a implante de drenagem no setor de glaucoma do Hospital Oftalmológico de Sorocaba no período de janeiro de 2004 a dezembro de 2006. No estudo foram avaliadas as seguintes características: sexo, idade, olho operado, tipo de glaucoma, número de cirurgias oculares anteriores, pressão intraocular prévia e após, conforme tempo de seguimento. Foram observadas a acuidade visual pré e pós-implante, o número de medicações antiglaucomatosas prescritas pós-implante, as principais complicações e reintervenções necessárias. Resultados:Entre os 92 pacientes a proporção foi de 60 (65,3%) do sexo masculino e 32 (34,7%) do feminino. Os principais tipos de glaucoma foram: 38,9% (n=37) secundário a transplante de córnea e 25,3% (n=24) glaucoma neovascular. A média da pressão intraocular pré-implante foi de 32 (±11,29) mmHg e pós-implante foi de 18, (±8,16) mmHg em 95 (100%) pacientes, 15,00 (±11,00) mmHg em 95 (100%), 16 (±11,64) mmHg em 54(55,7%) e 20 (±10,14) mmHg em 21 (21,6%) para o período de 2 meses,6 meses, 1 ano e 2 anos, respectivamente. As complicações mais frequentes foram extrusão do implante (8,5%) e atalamia (5,4%). Conclusão:Observou-se evolução satisfatória nos pós-implantes, independente das diversas causas do glaucoma. Neste estudo foi encontrada redução significante da pressão intraocular 2 meses, 1 ano e 2 anos (p<0,05). Ascomplicações tiveram ocorrência e evolução independente do tipo de glaucoma, número de cirurgias prévias, idade e sexo.

Purpose: To evaluate aspects of patients submitted to drainage implant procedures before and after surgery. Methods: A retrospective study was done, with patients submitted to drainage implant procedures in the Glaucoma Sector of the Hospital Oftalmológico de Sorocaba, from January, 2004 to December, 2006. The following characteristics were evaluated: gender, age, treated eye, glaucoma type, number of previousophthalmologic surgeries, previous intraocular pressure and check-ups. The visual acuity was observed before and after the implant, the number of glaucoma medications given after the implant, the main complications and the necessity of a second intervention. Results: Among the 92 patients, 65.3% (n=60) were male and 34.7% (n=32) were female. The main types of glaucoma were 38.9% (n=37) dueto cornea transplant and 25.3% (n=24) to neovascular glaucoma. The intraocular pressure average before implant was 32 (±11.29) mmHg and after implant it was 18 (±8.11) mmHg in100% (n=95) eyes, 15 (± 10.89) mmHg in 100% (n= 95), 16 (±11.64) mmHg in 55.7% (n=54) and 20 (±10.31) mmHg in 21.6% (n=21) for the period of 2 months, 6 months, 1 and 2 years, respectively. The most frequent complications were implant migration (8.5%) and shallow anterior chamber(5.4%). Conclusion: A satisfactory evolution in the patients after implants, taking into consideration several causes of glaucoma. A significant reduction of intraocular pressure was found in the period of 2 months, at 1 and 2 years (p< 0.05). The complications occurred and progressed independent of the type of glaucoma, number of previous surgeries, age or gender.

Current profile of secondary glaucomas.

PURPOSE: To study the current profile of secondary glaucomas for their incidence and to identify risk factors. Materials and Methods: In this retrospective chart review, 2997 patients newly diagnosed and referred with glaucoma to our tertiary glaucoma center in the year 2005 were included. Evaluation of all cases was done on the basis of a detailed history and recorded examination including vision, intraocular pressure (IOP), anterior segment examination, gonioscopy and fundus evaluation by glaucoma specialists. Demographic data, etiology of secondary glaucoma, and any other significant findings were noted. RESULTS: Of 2997 referred patients, 2650 had glaucoma or were glaucoma suspects. Of all glaucoma patients or glaucoma suspects, 579 patients (21.84%) had secondary glaucoma. Age distribution was as follows: 25% were between 0-20 years; 27% were between 21-40 years; 30% were between 41-60 years and 18% were > 60 years. The male female ratio was 2.2. Frequent causes of secondary glaucoma were post - vitrectomy 14%, trauma 13%, corneo-iridic scar 12%, aphakia 11%, neovascular glaucoma 9%. Post-vitrectomy glaucoma eyes had vitreous substitutes in 83% cases of which 66% eyes had retained silicone oil for more than three months. Vision <or=20/200 was present in 63% eyes, 57% eyes had baseline IOP > 30 mm Hg. Of all traumatic glaucoma patients, 71% cases were < 30 years of age. Fifty per cent had baseline IOP of> 30 mm Hg and vision <or=20/200. CONCLUSIONS: Most patients with secondary glaucoma have poor vision (<or=20/200) with high IOP and advanced fundus changes at presentation.

Glaucoma disease patterns at a tertiary training hospital

Objective: To determine the occurrence of the various types of glaucoma seen at the Ophthalmology Department of a tertiary training hospital. Methodology: Descriptive study based on the medical records available at the glaucoma clinic of a tertiary training hospital from January 1999 to August 2000 Results: 310 medical records were reviewed of which 34.84 percent were of males and 65.16 percent females. 84 percent of the patients were older than 40 years old. 54.83 percent of the patients had primary glaucomas of which primary angle closure (34.83 percent) was the most common followed by the open angle type (20 percent). 12.58 percent of the patients had secondary glaucomas Conclusion: The predominant form of glaucoma in the region remains to be primary angle closure and this has been demonstrated in this present study.

Uso de la Milamicina C instalada, como profilaxis en la recurrencia de Pterigiones: en pacientes intervenidos quirúrgicamente en el Centro Nacional de Oftalmología

El presente estudio tiene como objetivo identificar el efecto de la Mitomicina C 0.02, instalada en el postoperatorio, en 20 pacientes escogidos al azar, con historias de 1 a 5 recurrrencias de pterigion. Los sujetosdel estudio se intervinieron entre los meses de septiembre y noviembre de 1998, con la técnica de escisión simple. En el primer día postoperatorio cada pacientes inició el uso de Mitomicina C al 0.02, una gota cada 8 horas, durante 5 días.El corte evaluativo se realizó cuando todos los pacientes tenían por lo menos 3 meses de intervenidos, 2 pacientes presentaron retardo en reepitelización conjuntiva durante las 2 primeras semanas de postoperatorio, que remitieron al final de este período. Dos pacientes presentaron recurrencia (10), teniendo estos las características de historia de más de una recidiva anterior, del grupo etáreo de25 a 34 años, además que fueron intervenido 1 año después de su ultima recurrencia. Se concluyó que el uso de Mitomicina C como porfilaxis en prevenir la recurrencia, es un método seguro y eficaz; y que los pacientes mas jovenes (grupo de 15 a 34 años), del sexo masculino, y con historia de más de recurrencia anterior, o recurrencia última de un año o menor, tienen mayor probalidad de enfrentar una nueva recidiva, aún con el uso de la profilaxis. Se recomendó preferir la técnica de escisión simple más la instalación postquirúrgica de Mitomicina C, a fin de evitar las recurrencias...

Estudo de valores estereométricos em olhos glaucomatosos e normais pela tomografia neuro-retiniana: projeto piloto / Stereometric evaluation of normal and glaucomatous eyes by confocal laser scanning technique

Utilizando a técnica de confocal laser scanning, com o aparelho Heidlberg Retina Tomograph, estudamos parâmetros estereométricos determinados por este instrumento, HVC (variaçäo de espessura da camada de fibras nervosas - CFN), MHC (espessura média da CFN), VAR (volume do anel neuro-retiniano) e TM (formato do disco óptico) quanto à sua capacidade de diferenciar olhos glaucomatosos de olhos normais, com discos ópticos com área normal e grande. Foram estudados 98 olhos, sendo a imagem média de 20 olhos utilizada para verificar-se a reprodutibilidade do traçado da linha de contorno ao redor do disco óptico (p=0,254). Medidas as áreas dos 98 discos ópticos, obteve-se uma média de 2,36 ñ 0,61mm2, dividindo-se, assim, 37 pacientes em 03 grupos

Glaucomas / The glaucomas

Neste capítulo, o assunto - Glaucomas - é apresentado como ministrado aos alunos de graduaçäo da Faculdade de Medicina de Ribeiräo Preto, USP.

The role of 5-fluorouracil in complicated glaucomas.

The long-term efficacy of trabeculectomy in controlling intraocular pressure (IOP) has been found unsatisfactory in various complicated and refractory glaucomas. The most common cause for failure is excessive scarring at the filtering site. Several wound modulating agents which reduce scarring have been tested. In this study, 5-Fluorouracil (5-FU), a halogenated pyrimidine analogue and a potent anti-mitotic agent, was applied for seven days after trabeculectomy in eighteen complicated and unsuccessful filtering glaucomas, at a daily dosage of 5 mg in the form of 0.5 ml subconjunctival injections. The common postoperative complications encountered were corneal epithelial erosion (38%), wound leakage (16%), subconjunctival haemorrhage (32%) and hyphaema (10%), all during the first 7 to 10 days. Monitoring at regular intervals up to six months showed adequate control of IOP (less than 22mm Hg.) in 88% of the cases. Cases of aphakic glaucoma and neovascular glaucoma showed poor response. Use of 5-FU as an adjuvant to filtering surgery in various complicated glaucomas improves the long-term results.

Trabeculectomía en el Hospital Bertha Calderón Roque durante el período enero 1988-diciembre 1989 / Trabeculectomy the Hopistal Bertha Calderon Roque during the period. january 1980-december 1989

Se realizó un estudio descriptivo transversal, retropectivo en pacientes operados por glaucoma de diferentes tipos, con el objetivo de conocer el comportamiento post-trabeculectomía efectuada en el Hospital Bertha Calderón Roque, en el período de enero 1988-diciembre 1989. La trabeculectomía representa el 8 porciento del total de las cirugías oftalmológicas en dicho centro. El 61.3 porciento fueron del sexo femenio. El 64 porciento de las cirugía se efectuaron en pacientes mayores de 40 años, pero también se destaca el grupo de 0-9años con el 19.3 porciento de los mismos. En relación a las complicaciones el 81.5 porciento de las cirugía fueron existosas. El 4.2 porciento se acompañó de uveitis (la que con medicamentos) un 4.2 porciento también presentó cámara plana aosciada a Hipotomía. El glaucoma de ángulo cerrado crónico simple aparecen como las principales causas de indicación para la trabeculectomía. El 68 porciento delos pacientes presentarón presión intraocular mayor de 41mm Hg. pre-operatoria. El 58.2 porciento de los pacientes presentaron una presión intraocular menor de 20mm Hg. con más de seis semanas de evolución. Le llegó a conclusiones y recomendaciones...

Comparaçäo biométrica entre diferentes tipos de glaucoma e sua importância clínica / Biometric comparison between the various types of glaucoma

Os Autores estudaram biomedicamente 63 pacientes (93 olhos) classificados em sete grupos: Olhos normais, olhos com glaucoma crônico simples e diferentes formas de glaucoma de ângulo estreito e hipermétropes elevados (>=6D). Concluem que a biometria ocular, embora diferencie os pacientes com glaucoma de ângulo estreito dos pacientes normais e com glaucoma de ângulo aberto, é incapaz de separar as diferentes formas de glaucoma de ângulo estreito e também hipermétropes com seio camerular amplo

Incidencia de glaucoma en la consulta externa del Hospital Edgardo Rebagliati Martins del Instituto Peruano de la Seguridad Social / Glaucoma incidence in out patients of the Hospital Eduardo Rebagliati

Se revisan 2,141 Historias Clínicas de casos diagnosticados con Glaucoma Primario de Angulo Abierto, Glaucoma Primario de Angulo Estrecho y Glaucoma Secundario Inducido por el Uso Tópico de Esteroides, en el lapso de 5 años y 8 meses; se encuentra una incidencia, referida a la población general estudiada, del 3 por ciento para estos tres tipos de glaucomas en conjunto; de este porcentaje el 2.6 por ciento corresponde al Glaucoma Primario de Angulo Abierto y el 0.4 por ciento a los dos restantes. La quinta y sexta décadas de la vida son las más afectadas, con 29.2 por ciento y 36.4 por ciento respectivamente. El sexo masculino con 52.2 por ciento muestra prevelencia sobre el femenino con 47.5 por ciento. La incidencia de Ceguera Legal imputable a estos glaucomas, en la población registrada como glaucomatosa, asciende a 17.93 por ciento