SD-OCT assessment and visual field changes 1 year or more after a single episode of unilateral acute primary angle closure / Avaliação do SD-OCT e mudanças do campo visual 1 ano ou mais após episódio único de fechamento angular primário agudo unilateral

ABSTRACT Objective: To evaluate structural and visual field (VF) changes after ≥1 year of a single acute primary angle closure (APAC) attack using spectral-domain optical coherence tomography (SD-OCT) and standard automated perimetry (SAP). Methods: Patients with a single unilateral APAC crisis at least 1 year ago were included consecutively from 2013 to 2016. Contralateral eye was used as control. All patients underwent ophthalmic examination, RNFL imaging by SD-OCT, and SAP using Octopus 1-2-3. Results: 54 eyes (27 patients) were enrolled. Male-to-female ratio was 1:2. Mean time for the SD-OCT and SAP assessment after the crisis was 5.0±5.1 (1.0-23.5) years, and IOP was 52.5±9.8 mmHg. In APAC eyes, the thicknesses of all quadrants of peripapillary RNFL (36.3%; P<0.001) and some macular sections (from 2.1% to 4.7%; P<0.01) were reduced compared to contralateral eyes. Additionally, in APAC eyes, the mean defect on VF was negatively and statistically correlated with the reduction of all quadrants of peripapillary RNFL thickness. Conclusion: A single episode of APAC was associated with peripapillary RNFL and macular thickness and with VF defects after ≥1 year of the crisis in the affected eye. Statistically meaningful correlations were found between structural and functional damage.

RESUMO Objetivo: Avaliar alterações estruturais e do campo visual 1 ano ou mais após uma crise única de fechamento angular primário agudo utilizando tomografia de coerência óptica de domínio espectral e perimetria automatizada padronizada. Métodos: Pacientes que apresentaram crise unilateral única de fechamento angular primário agudo há pelo menos 1 ano foram consecutivamente incluídos entre 2013 e 2016. Os olhos contralaterais foram utilizados como controles. Todos os pacientes foram submetidos a exame oftalmológico, avaliação das camadas de fibras nervosas da retina utilizando tomografia de coerência óptica de domínio espectral e perimetria automatizada padronizada com o Octopus 1-2-3. Resultados: Foram incluídos 54 olhos (27 pacientes) com razão homem:mulher de 1:2. O tempo médio após a crise foi de 5,0±5,1 anos (1,0 a 23,5) e a pressão intraocular na crise foi 52,5±9,8mmHg. Nos olhos com fechamento angular primário agudo, todas as espessuras das camadas de fibras nervosas da retina peripapilares (36,3%; p<0,001) e de algumas seções maculares (de 2,1 a 4,7%; p<0,01) estavam reduzidas em comparação aos olhos contralaterais. Além do mais, nos olhos submetidos a fechamento angular primário agudo, o mean defect do campo visual foi estatisticamente e negativamente correlacionado com a redução da espessura de todos os quadrantes peripapilares da camada de fibras nervosas da retina. Conclusão: Um único episódio de fechamento angular primário agudo foi associado com redução na espessura da camada de fibras nervosas da retina peripapilar e da espessura macular e com defeitos de campo visual 1 ano ou mais após a crise no olho afetado. Correlações estatisticamente significativas foram identificadas entre danos estruturais e funcionais.

Evaluation of choroidal thickness and retinal nerve fiber layer thickness in patients with unilateral amblyopia: a prospective study / Avaliação da espessura da coroide e da camada de fibras nervosas da retina em pacientes com ambliopia unilateral: um estudo prospectivo

ABSTRACT Purpose: to compare the Subfoveal choroidal thickness (SFCT) and Retinal Nerve Fiber Layer Thickness (RNFL) of amblyopic and normal fellow eyes. Design: Prospective, cross-sectional, observational case series. Methods: Forty patients age 12 to 41 years (mean 23.73 ± 6.42) with unilateral amblyopia were studied. Among them, 11(28.2%) patients had amblyopia secondary to strabismus and 29(71.8 %) had anisometropic amblyopia. Optical coherence tomography (OCT) of the peripapillary RNFL thickness of amblyopic and fellow eyes was performed. RNFL thickness measurements were taken from the superior, inferior, nasal and temporal quadrants in the peripapillary region. Also, subfoveal choroidal thickness (SFCT) was measured using spectral domain optical coherence tomography (SD-OCT). Results: Mean global RNFL thickness of the amblyopic and fellow eyes was 104.48 microns and 102.83 microns, respectively. The difference between the two groups was not statistically significant (p>0.05%). The thicknesses of the superior, inferior, nasal and temporal quadrants of the retinal nerve fiber layer between the amblyopic and normal fellow eyes showed no statistically significant difference (p>0.05%). However, the SFCT of amblyopic eye was 11 or more microns thicker than the fellow eye and this was statistically significant different (p<0.05%). Conclusions: This study demonstrated SFCT in amblyopic eyes was significantly thicker than the normal fellow eyes. The amblyopic process may involve the choroid, but not the prepapillary NFL.

RESUMO Objetivo: comparar a espessura da coroide subfoveal (CSF) e da camada de fibra nervosa retinal (CFNR) de olhos amblíopes e normais. Design: série de casos prospectivos, transversais e observacionais. Métodos: Quarenta pacientes com idade entre 12 e 41 anos (média 23,73 ± 6,42) com ambliopia unilateral foram estudados. Entre eles, 11 (28,2%) pacientes apresentavam ambliopia secundária a estrabismo e 29 (71,8%) apresentavam ambliopia anisometrópica. Foi realizada tomografia de coerência óptica (TCO) da espessura da CFNR peripapilar do olho amblíope e do outro olho. As medidas de espessura da CFNR foram realizadas nos quadrantes superior, inferior, nasal e temporal na região peripapilar. Além disso, a espessura da coroide subfoveal (CSF) foi medida através de tomografia de coerência óptica de domínio espectral (TCO-DE). Resultados: A espessura média global da CFNR do olho amblíope e do outro olho foi de 104,48 mícrons e 102,83 mícrons, respectivamente. A diferença entre os dois grupos não foi estatisticamente significativa (p > 0,05%). As espessuras dos quadrantes superior, inferior, nasal e temporal da camada de fibras nervosas da retina entre o olho amblíope e o normal não apresentaram diferença estatisticamente significativa (p > 0,05%). No entanto, a CSF do olho amblíope foi 11 mícrons mais espessa (ou mais) do que a do outro olho - essa diferença foi estatisticamente significativa (p < 0,05%). Conclusões: Este estudo demonstrou que a CSF dos olhos amblíopes foi significativamente mais espessa do que a dos olhos normais. O processo amblíope pode envolver a coroide, mas ele não envolve a CFNR peripapilar.

Reversal of cupping em glaucoma juvenil tratado com análogo de prostaglandina tópica / Reversal of cupping in juvenile glaucoma treated with topical prostaglandin analogue

Resumo A reversão da escavação é uma entidade rara que se refere à redução da escavação do disco óptico em resposta à diminuição sustentada dos níveis de pressão intra-ocular (PIO), em cerca de 25% da PIO basal. A ocorrência deste fenômeno apenas com o tratamento clínico é pouco relatada na literatura, Este estudo relata um caso de um paciente com glaucoma juvenil, que apresentou à gonioscopia ângulo aberto e tomografia de coerência óptica (OCT) com uma diminuição significativa na camada de fibras nervosas retinianas em ambos os olhos. Após um ano utilizando análogos de prostaglandina tópica e manutenção de níveis baixos de PIO, ocorreu diminuição da escavação do nervo óptico, que foi confirmada pelos padrões topográficos da OCT. O "reversal of cupping" é um sinal da diminuição da tensão ao nível da lâmina crivosa e está provavelmente associada a uma redução do risco para a progressão do glaucoma a longo prazo, sem melhora da função visual.

Abstract Reversal of cupping is a rare entity, characterized by the reduction of optical disc cupping in response to sustained decrease in intraocular pressure (IOP) levels by 25% of the basal IOP. The occurrence of this phenomenon with clinical treatment is rarely reported in the literature. This study reports a case of a patient with juvenile glaucoma with augmented cupping, significant decrease in the retinal nerve fiber layer in both eyes and altered topografic measures in optical coherence tomography (OCT). After one year using topical prostaglandin analog and keeping low IOP levels, a decrease in optic nerve cupping was detected in rethinography, confirmed by the improvement of OCT topographic measures. Reversal of cupping is a sign of decreased tension at the level of the lamina cribosa and is probably associated with a reduced risk for long-term progression of glaucoma without improvement of visual function.

The effect of panretinal photocoagulation on confocal laser scanning ophthalmoscopy and stereo photographic parameters of optic disk topography in patients with diabetic retinopathy / Efeito da panfotocoagulação retiniana na oftalmoscopia confocal de varredura a laser e parâmetros da estereofotografia do disco óptico em pacientes com retinopatia diabética

ABSTRACT Purpose: To determine the effect of panretinal photocoagulation on optic disk topographic parameters in non-glaucomatous patients with proliferative diabetic retinopathy. Methods: This was a prospective, single-center, observational study. Thirty-eight eyes of 26 patients with diabetes underwent panretinal photocoagulation for proliferative diabetic retinopathy. Stereoscopic disk photographs and optic nerve head parameters were evaluated using the Zeiss fundus camera and the confocal scanning laser ophthalmoscope (Heidelberg Retinal Tomograph), respectively, at baseline and 12 months after the completion of panretinal photocoagulation. Results: Thirty-eight eyes of 26 patients (15 female) with a mean age of 53.7 (range 26-74) years were recruited. No significant difference was found between the stereo photography determined mean horizontal and vertical cup-to-disk ratio before and after panretinal photocoagulation treatment (p=0.461 and 0.839, respectively). The global values of the optic nerve head parameters analyzed with the HRT3 showed no significant change from baseline to 12 months, including the disk area, cup area, rim area, cup volume, rim volume, cup-to-disk area ratio, linear cup-to-disk ratio, mean cup depth, maximum cup depth, cup shape measure, height variation contour, mean retinal nerve fiber layer thickness, and cross-sectional area. Conclusion: Our results suggest that panretinal photocoagulation does not cause morphological optic disk changes in patients with diabetic proliferative retinopathy after 1 year of follow-up.

RESUMO Objetivo: Determinar o efeito da panfotocoagulação retiniana nos parâmetros topográficos do disco óptico em pacientes não glaucomatosos com retinopatia diabética proliferativa. Métodos: Este é um estudo observacional pros­pectivo e unicêntrico. Trinta e oito olhos de 26 pacientes dia­béticos foram submetidos à panfotocoagulação retiniana para retinopatia diabética proliferativa. As estereofotografias e os parâmetros do disco óptico foram avaliados usando o retinógrafo Visucam da Zeiss e o oftalmoscópio confocal de varredura a laser (Heidelberg Retinal Tomograph), respectivamente, no início e 12 meses após a conclusão da panfotocoagulação. Resultados: Trinta e oito olhos de 26 pacientes (15 mulheres) com média de idade de 53,7 anos (intervalo de 26-74) foram recrutados. Nenhuma diferença significativa foi encontrada entre a média horizontal e vertical para relação escavação/disco óptico determinadas pelas estereo­fotografias antes e após o tratamento com panfotocoagulação retiniana (p=0,461 e 0,839, respectivamente). Os valores globais dos parâmetros do disco óptico analisados com a tomografia de varredura a laser não mostraram nenhuma mudança significativa entre o início até os 12 meses, incluindo disk area, cup area, rim area, cup volume, rim volume, C/D area ratio, linear C/D ratio, mean cup depth, maximum cup depth, cup shape measure, height variation contour, mean retinal nerve fiber layer thickness e cross-sectional area. Conclusão: Nossos resultados sugerem que a panfotocoagulação retiniana não causa alterações morfológicas no disco óptico em pacientes com retinopatia diabética proliferativa após um ano de seguimento.

Clinical and epidemiological study in patients with primary open-angle glaucoma / Estudo clínico-epidemiológico em indivíduos com glaucoma primário de ângulo aberto

Abstract Objective: To evaluate the clinical and epidemiological profile of patients with primary open-angle glaucoma. Methods: This is a quantitative study with cross-sectional and analytical design, which sample consisted of 425 patients treated in an unit of Specialized Care in Ophthalmology, located in the northern state of Minas Gerais, from 2004 to 2015. We collected the data using formularies that addressed demographic and clinical aspects, risk factors and the presence of undercurrent diseases. We conducted an ophthalmological examination to evaluate anatomical and functional changes. We used statistical analysis, and the results are presented by mean, standard deviation and percentiles 25, 50 and 75. Results: Females predominate (56.8%), the age group of 60 years or older (44%) and mixed skin (81.7%). A minority of participants present risk factors such as high myopia (6.3%) and diabetes mellitus (17.9%). Regarding the clinical examination, there is a prevalence of increased optic nerve excavation (≥ 0.8) and low thickness of the corneas (≤ 535 microns). Conclusion: Most people develop advanced glaucoma, with increased optic nerve excavation and changed visual fields. Other common risk factors are: family history of glaucoma, decreased thickness of the cornea and hypertension. Early diagnosis and treatment can prevent vision loss. Primary care physicians should consider referring patients who have glaucoma risk factors, for an ophthalmologic examination.

Resumo Objetivo: Avaliar o perfil clínico-epidemiológico dos indivíduos com glaucoma primário de ângulo aberto. Métodos: Trata-se de estudo quantitativo com desenho transversal e analítico, mediante amostra constituída de 425 pacientes atendidos em uma Unidade de Atenção Especializada em Oftalmologia localizada no norte do estado de Minas Gerais, Brasil, cadastrados no período de 2004 a 2015. As variáveis analisadas foram: características demográficas e clínicas, fatores de risco e presença de doenças associadas. Foi realizado exame oftalmológico para avaliar alterações anatômicas e funcionais. Para as análises estatísticas foram utilizados os programas Statistical Package for the Social Sciences (SPSS), versão 19.0. Considerou-se nível de significância p<0,05 para as variáveis categóricas. As variáveis descritivas foram apresentadas pela média, desvio-padrão e percentis 25, 50 e 75. Resultados: Predominou o gênero feminino (56,8%), a faixa etária de 60 anos ou mais (44%), e a cor da pele parda (81,7%). Fatores de risco como alta miopia (6,3%) e diabetes mellitus (17,9%) foram relatados pela minoria dos participantes. Em relação ao exame clínico, houve prevalência de escavação do nervo óptico aumentada (≥ 0,8 mm2) e baixa espessura central das córneas (≤ 535 micras). Conclusão: A maioria dos indivíduos apresenta glaucoma avançado, com escavações do nervo óptico aumentadas e campos visuais alterados. Outros fatores de risco frequentes foram: história familiar positiva para glaucoma, espessura central da córnea diminuída e hipertensão arterial sistêmica. Diagnóstico e tratamento precoces podem prevenir contra a perda de visão no glaucoma. Médicos da atenção primária à saúde devem encaminhar os pacientes que tenham fatores de risco para glaucoma, para a consulta especializada e exames oftalmológicos.

Coexistence of optic pit and coloboma of iris, lens, and choroid: a case report / Coexistência de fosseta óptica e coloboma de íris, cristalino e coroide: um primeiro relato de caso

ABSTRACT A 42-year-old woman was admitted to our clinic with a complaint of glare in both eyes. Biomicroscopic examination of both the eyes revealed iris and lens colobomas in the inferior quadrant. Fundus examination of the right eye revealed an oval and gray inferotemporal optic pit and two choroid colobomas in the inferior quadrant. In the left eye, two choroid colobomas were detected that were inferior to the optic nerve head. Furthermore, a 21-year-old man presented to our clinic for a routine ophthalmologic examination. Bilateral biomicroscopic examination was normal. Fundus examination of the left eye revealed an oval and gray inferotemporal optic pit and a choroid coloboma that was inferior to the optic nerve head. Here we describe optic pits co-occurring with iris, lens, and choroidal colobomas. On the basis of these cases, a defect in the closure of the embryonic fissure is the most plausible etiology of the optic pit.

RESUMO Uma mulher de 42 anos de idade foi internada em nossa clínica com queixa de ofuscamento em ambos os olhos. O exame biomicroscópico revelou coloboma de íris e cristalino no quadrante inferior em ambos os olhos. O exame de fundo do olho direito revelou um fosseta óptica oval e acinzentada na região inferotemporal e dois colobomas coroide no quadrante inferior. No olho esquerdo, dois colobomas de coroide foram detectados inferiormente à da cabeça do nervo óptico. Outro homem de 21 anos apresentou-se em nossa clínica para um exame oftalmológico de rotina. O exame biomicroscópico foi normal, bilateralmente. O exame de fundo do olho esquerdo revelou uma fosseta oval e acinzentada de nervo óptico óptico inferotemporal e um coloboma coroide inferior à cabeça do nervo óptico. Nestes relatos nós descrevemos fossetas ópticas ocorrendo simultaneamente com colobomas de íris, cristalino, e coroide. Com base nestes casos, o defeito no fechamento da fissura embrionária é uma provável etiologia da fosseta óptica.

Corneal structure in tilted disc syndrome / Estrutura da córnea na síndrome de disco inclinado

ABSTRACT Purpose: To evaluate the central corneal thickness (CCT), corneal volume (CV), and anterior and posterior corneal surfaces using the Scheimpflug imaging system in patients diagnosed with tilted disc syndrome (TDS). Methods: The study group (Group 1) and the control group (Group 2) comprised 35 eyes of 35 age-, sex-, and refraction-matched cases. All cases underwent a full ophthalmic examination that included cycloplegic refraction, axial ocular length measurement, and Scheimpflug imaging. Results: The mean age was 34.68 ± 15.48 years in Group 1 and 34.11 ± 12.01 years in Group 2 (p=0.864). The gender distribution was 18 males and 17 females in Group 1 and 16 males and 19 females in Group 2 (p=0.618). All subjects were Caucasian. The spherical equivalent was 3.62 ± 1.75 D in Group 1 and 3.69 ± 1.51 D in Group 2 (p=0.850). There was no significant difference in age, sex, race, or spherical equivalent between groups. There was no significant difference in mean keratometric value and CV3 (the CV in the central 3 mm) between groups (p=0.232 and 0.172, respectively). There were statistically significant differences in CCT, CV5, and CV7 (CV in the central 5 and 7 mm3, respectively) and total CV between groups (p=0.008, 0.003, 0.023, and 0.019, respectively). The values of all parameters were lower in the study group than in the control group. There was also a statistically significant difference in the anterior elevation parameters of the cornea between groups (p<0.05). The mean values of Group 1 were higher than those of Group 2. There were statistically significant differences in the two parameters referring to the posterior elevation of the cornea between the two groups (p<0.05). Conclusion: The results of this study showed that eyes with TDS have thinner CCT, lower CV, and different anterior corneal curvature than normal eyes.

RESUMO Objetivo: Avaliar a espessura central da córnea (CCT), o volume de córnea (CV), e a superfície corneana anterior e posterior utilizando sistema de imagem Scheimpflug em pacientes com diagnóstico de síndrome do disco inclinado (TDS). Métodos: O grupo de estudo (grupo 1) e o grupo controle (grupo 2) consistiu de 35 olhos de 35 pacientes pareados por idade, sexo e refração em cada grupo. Todos os casos foram submetidos a um exame oftalmológico completo incluindo refração sob cicloplegia, medida do comprimento axial ocular e avaliação por Scheimpflug. Resultados: A idade média foi de 34,68 ± 15,48 anos no grupo 1 e 34.11 ± 12,01 anos no grupo 2 (p=0,864). A distribuição por sexo foi de 18 homens e 17 mulheres do grupo 1 e 16 homens e 19 mulheres no grupo 2 (p=0,618). Todos os indivíduos eram caucasianos. O equivalente esférico foi 3,62 ± 1,75 D no Grupo 1 e 3,69 ± 1,51 D no Grupo 2 (p=0,850). Não houve diferença significativa entre os dois grupos para idade, sexo, raça e equivalente esférico. Não houve diferença significativa entre os dois grupos para o valor médio ceratométrico e CV3 (o volume da córnea na central 3 mm) (p=0,232, p=0,172, respectivamente). Houve diferença estatisticamente significativa entre os dois grupos para CCT, CV5, CV7 (volume de córnea na região central 5 e 7 mm, respectivamente) e CV total (p=0,008, p=0,003, p=0,023 e p=0,019, respectivamente). Os valores do grupo de estudo foram menores do que o grupo controle para todos os parâmetros. Houve também diferença estatisticamente significativa entre os dois grupos nos parâmetros elevação anterior da córnea (p<0,05). Os valores médios do grupo 1 foram maiores do que o grupo 2. Não houve diferença entre os dois grupos para os dois parâmetros referentes à elevação posterior da córnea (p<0,05). Conclusões: Nosso estudo mostrou que os olhos com TDS apresentam CCT mais fina, menor volume da córnea e alterações na curvatura corneana anterior quando comparados aos olhos normais.

Comparison of the Progression of High- and Low-tension Glaucoma as Determined by Two Different Criteria

PURPOSE: To investigate and compare the progression of medically treated primary open angle glaucoma according to the baseline intraocular pressure (IOP). METHODS: This study included a total of 345 eyes from 345 patients (mean follow-up period, 4.5 years). Eyes were classified into either conventional normal tension glaucoma (cNTG, 21 mmHg) groups according to the conventional cut-off value of the IOP. Additionally, the median IOP (15 mmHg) was used to create two other groups (median NTG [mNTG] 15 mmHg). Using these values, 306, 39, 153, and 192 eyes were assigned to the cNTG, cHTG, mNTG, and mHTG groups, respectively. Glaucoma progression was determined either by optic disc/retinal nerve fiber layer photographs or serial visual field data. RESULTS: Mean reduction of IOP after medical treatment and of central corneal thickness was lower in the cNTG group, while the prevalence of disc hemorrhage and baseline visual field mean deviation did not differ between the cNTG and cHTG groups. A mean reduction in the IOP was observed after medical treatment, and central corneal thickness was lower in the mNTG group; disc hemorrhage was more frequent in the mNTG than in the mHTG group. Among the 345 analyzed eyes, 100 (29%) showed progression during the follow-up period. In the cHTG group, a higher baseline IOP (hazard ratio, 1.147; p = 0.024) was associated with glaucoma progression. Disc hemorrhage (hazard ratio, 15.533; p < 0.001) was also strongly associated with progression in the mNTG group. CONCLUSIONS: Baseline IOP was a significant risk factor for glaucoma progression in cHTG patients (10% of our total participants), while disc hemorrhage showed the strongest association with progression in the mNTG group, indicating that a cut-off value other than the conventional 21 mmHg is required to define true low-tension glaucoma in populations where NTG predominates among all glaucoma patients.

Peripapillary retinal nerve fiber layer and choroidal thickness in cirrhosis patients / Espessura da camada de fibras nervosas peripapilares da retina e coroide em pacientes com cirrose

ABSTRACT Purpose: To evaluate the effect of cirrhosis on peripapillary retinal nerve fiber layer and choroidal thickness with enhanced depth imaging optical coherence tomography. Methods: This cross sectional, single center study was undertaken at Bulent Ecevit University Ophthalmology department with the participation of internal medicine, Gastroenterology department. Patients who were treated with the diagnosis of cirrhosis (n=75) were examined in the ophthalmology clinic. Age and sex matched patients (n=50) who were healthy and met the inclusion, exclusion criteria were included in the study. Complete ophthalmological examination included visual acuity with Snellen chart, intraocular pressure measurement with applanation tonometry, biomicroscopy of anterior and posterior segments, gonioscopy, axial length measurement, visual field examination, peripapillary retinal nerve fiber layer, central macular and subfoveal choroidal thickness measurements. Results: The difference between intraocular pressure values was not statistically significant between cirrhosis and control group (p=0.843). However, mean peripapillary retinal nerve fiber layer thickness was significantly thinner in cirrhosis group in all regions (p<0.001) and subfoveal choroidal thickness was significantly thinner in cirrhosis group also (p<0.001). Moreover, central macular thickness of cirrhosis group was significantly thicker than the control group (p=0.001). Conclusion: Peripapillary retinal nerve fiber layer and subfoveal choroidal thickness was significantly thinner in cirrhosis patients.

RESUMO Objetivo: Avaliar o efeito da cirrose na camada de fibras nervosas da retina e na espessura da coroide através da tomografia de coerência óptica com imagem de profundidade aprimorada. Métodos: Este estudo transversal, de único centro, foi realizado no departamento de Oftalmologia da Universidade Bulent Ecevit com a participação do departamento de medicina interna em gtastroenterologia. Os pacientes que foram tratados com o diagnóstico de cirrose (n = 75) foram examinados na clínica da oftalmologia. Foram incluídos pacientes correspondentes em idade e sexo (n = 50) que fossem saudáveis e possuíssem o critério de inclusão exigido pelo estudo. Realização de exame oftalmológico completo: acuidade visual com tabela de Snellen, a medida da pressão intraocular com tonometria de aplanação, biomicroscopia do segmento anterior e posterior, gonioscopia, medida do comprimento axial, exame de campo visual, camada de fibras nervosas da retina, macular central e medidas de espessura de coroide. Resultados: A diferença entre os valores de pressão intraocular não foram estatisticamente significativos entre os grupos cirrótico e controle (p=0,843). Entretanto, a espessura da camada de fibras nervosas da retina foi significativamente mais fina no grupo cirrótico em todas as regiões (p=0,001) e a espessura subfoveal da coroide também foi significativamente mais fina no grupo cirrótico (p=0,001). Além disso, a espessura macular central do grupo cirrótico foi significativamente mais grossa do que no grupo de controle (p=0,001). Conclusão: Por fim, as espessuras das camadas de fibras nervosas da retina e subfoveal da coroide foram significativamente mais finas nos pacientes com cirrose.

Diagnóstico e conduta em melanocitoma do disco óptico / Diagnosis and management of optic disc melanocytoma

RESUMO O melanocitoma do disco óptico é um tumor benigno, com pouca predisposição a transformação maligna para melanoma. Geralmente é assintomático, contudo deve ser avaliado periodicamente com exames, sendo um deles a campimetria computadorizada que se encontra alterada em 90% dos casos. Relatamos o caso de um homem de 61 anos sem diagnóstico prévio de melanocitoma do disco óptico. Discute-se a importância de um diagnóstico diferencial com melanoma e acompanhamento seriado do paciente.

ABSTRACT The optic disc melanocytoma is a benign tumor, with little predisposition to become a melanoma. It is usually asymptomatic, nonetheless should be evaluated periodically, most often by computerized perimetry, which in 9 out of 10 cases will show some alteration. In the following paper we report the case of 61 years old man without previous diagnosis of optic disc melanocytoma and discuss the importance of melanoma differential diagnosis and monitoring.

Ophthalmic Doppler in persistent hyperplastic primary vitreous atypical presentation: case report / Doppler oftálmico na persistência hiperplásica do vítreo primário de apresentação atípica: relato de caso

ABSTRACTThe purpose is to document a case of persistent hiperplastic primary vitreous (PHPV) with atypical Bergmeister's papilla and patent hialoid artery that had its conclusive diagnosis done by doppler ultrasound. We report a case of child, who had unilateral leucokoria. This child's fundoscopic examination showed a white mass on the optic nerve that extended over to adjacent retina. Performed ultrasound that remained a doubt with the following diagnostic hypotheses: persistent hiperplastic primary vitreous, granuloma (toxocara), astrocytic hamartoma and retinoblastoma. The diagnosis was only established when the doppler ultrasound showed a blood flow inside of the membrane, thus confirming the diagnosis of persistent hiperplastic primary vitreous associated with the Bergmeister'spapilla.

RESUMOO objetivo é documentar um caso de persistência hiperplásica do vítreo primário (PHPV) com papila de Bergmeister atípica e artéria hialóide pérvia que teve seu diagnóstico conclusivo feito pelo exame ultrassonográfico com Doppler colorido. Relatamos um caso de uma criança com leucocoria unilateral, apresentando massa branca sobre o disco óptico observada à fundoscopia, que se estendia à retina adjacente. Após a realização do exame ultrassonográfico foi mantida a dúvida com as seguintes hipóteses diagnósticas: persistência hiperplásica do vítreo primário, granuloma (toxocaríase) e retinoblastoma. O diagnóstico foi estabelecido após a utilização do Doppler colorido que evidenciou fluxo sanguíneo no interior da membrana, confirmando o diagnóstico de persistência hiperplásica do vítreo primário associada à papila de Bergmeister.

Therapeutic play: preparing the child for the vaccine / Brinquedo terapêutico: preparando a criança para a vacina

ABSTRACT Objective: To identify and compare behaviors of children during vaccination, who were prepared or not for the procedure using an instructional therapeutic play. Methods: A quasi experimental study, with quantitative approach of 60 children aged 3 to 6 years. The child's reactions were recorded in a checklist. Data were analyzed using descriptive and inferential statistics and Fisher's test. Results: The main reactions in the experimental group were stay still (25;83%) and spontaneously collaborate (24;80%). In the control group, the main reactions were cries and cling to parents (15; 50%), flushing (11;36.67%) and moving the body/agitated (10;33.3%). Conclusion: The reactions of cooperation were more frequent in the experimental group, while low acceptance was observed only in the control group. Therapeutic play has proved an important tool in preparing for the vaccine. .

RESUMO Objetivo: Identificar e comparar os comportamentos das crianças durante a vacinação, preparadas ou não para o procedimento com o brinquedo terapêutico instrucional. Métodos: Estudo quasi experimental, de abordagem quantitativa, com 60 crianças entre 3 e 6 anos. As reações da criança foram registradas em um formulário do tipo checklist. Os dados foram analisados por estatística descritiva e inferencial, e pelo teste de Fisher. Resultados: As principais reações no grupo experimental foram ficar quieta (25;83%) e colaborar espontaneamente (24;80%). No grupo controle, foram: chorar e agarrase aos pais (15;50%), rubor facial (11;36,67%) e movimenta-se/agitase (10;33,3%). Conclusão: As reações de cooperação foram mais frequentes no grupo experimental, enquanto as de menor aceitação foram observadas apenas no grupo controle. O brinquedo terapêutico revelou-se um importante instrumento no preparo para a vacina. .

Differences between Non-arteritic Anterior Ischemic Optic Neuropathy and Open Angle Glaucoma with Altitudinal Visual Field Defect

PURPOSE: To investigate the differences in retinal nerve fiber layer (RNFL) change and optic nerve head parameters between non-arteritic anterior ischemic optic neuropathy (NAION) and open angle glaucoma (OAG) with altitudinal visual field defect. METHODS: Seventeen NAION patients and 26 OAG patients were enrolled prospectively. The standard visual field indices (mean deviation, pattern standard deviation) were obtained from the Humphrey visual field test and differences between the two groups were analyzed. Cirrus HD-OCT parameters were used, including optic disc head analysis, average RNFL thickness, and RNFL thickness of each quadrant. RESULTS: The mean deviation and pattern standard deviation were not significantly different between the groups. In the affected eye, although the disc area was similar between the two groups (2.00 +/- 0.32 and 1.99 +/- 0.33 mm2, p = 0.586), the rim area of the OAG group was smaller than that of the NAION group (1.26 +/- 0.56 and 0.61 +/- 0.15 mm2, respectively, p < 0.001). RNFL asymmetry was not different between the two groups (p = 0.265), but the inferior RNFL thickness of both the affected and unaffected eyes were less in the OAG group than in the NAION group. In the analysis of optic disc morphology, both affected and unaffected eyes showed significant differences between two groups. CONCLUSIONS: To differentiate NAION from OAG in eyes with altitudinal visual field defects, optic disc head analysis of not only the affected eye, but also the unaffected eye, by using spectral domain optical coherence tomography may be helpful.

Associations between Optic Cup-to-disc Ratio and Systemic Factors in the Healthy Korean Population

PURPOSE: To assess the relationships between optic cup-to-disc ratio (CDR) and age, sex, and other demographic and health characteristics in the healthy Korean population. METHODS: The study design was retrospective and population-based. A total of 28,377 subjects who participated in the Korea National Health and Nutrition Examination Survey between 2008 and 2011 were enrolled in this study. Participants underwent structured interviews as well as systemic and ophthalmic examinations. Patients with glaucoma who were diagnosed using the International Society of Geographical and Epidemiological Ophthalmology classification were excluded. Changes in vertical CDR were examined by age in relation to systemic variables on multiple regression analysis. RESULTS: The mean vertical CDR was 0.34 +/- 0.12. The vertical CDR increased with age from subjects in their 20s to those in their 80s (p < 0.001). The mean CDR in males was significantly higher than that of females (p < 0.001). On multiple regression analysis, the vertical CDR was positively associated with age (p < 0.001), male sex (p < 0.001), diastolic blood pressure (p = 0.009), and intraocular pressure (p < 0.001) but was negatively associated with body mass index (p < 0.001). CONCLUSIONS: Greater vertical CDR was related to age, male sex, higher diastolic blood pressure, higher intraocular pressure, and lower body mass index in healthy Koreans.

Intravitreal Bevacizumab for the Treatment of Optic Disc Edema in a Patient with POEMS Syndrome

No abstract available.

Optic Disc Edema Responding to Localized Anti-vascular Endothelial Growth Factor Treatment in a Patient with POEMS Syndrome

No abstract available.

Comparison of Clinical Characteristics and Progression Rates of Bilaterally and Unilaterally Progressing Glaucoma

PURPOSE: To compare the clinical characteristics of unilaterally progressing glaucoma (UPG) and simultaneously bilaterally progressing glaucoma (BPG) in medically treated cases. METHODS: Primary open angle glaucoma patients were classified as having UPG or BPG according to an assessment of optic disc and retinal nerve fiber layer photographs and visual field analysis. Risk factors including the presence of systemic diseases (hypertension, diabetes, cerebrovascular accident, migraine, and dyslipidema) were compared between the UPG and BPG groups. Baseline characteristics and pre- and post-treatment intraocular pressure (IOP) were compared between the progressing eye (PE) and the non-progressing eye (NPE) within the same patient in the UPG group and between the faster progressing eye and the slower progressing eye in the BPG group. RESULTS: Among 343 patients (average follow-up period of 4.2 years), 43 were categorized into the UPG group and 31 into the BPG group. The prevalence of all analyzed systemic diseases did not differ between the two groups. PEs in the UPG group had more severe pathology in terms of baseline visual field parameters than NPEs (mean deviation -6.9 ± 5.7 vs. -2.9 ± 3.9 dB, respectively; p < 0.001). However, baseline IOP, mean follow-up IOP, and other clinical characteristics were not significantly different between the PE and the NPE in the UPG group. The progression rate was significantly higher in the faster progressing eye in patients with BPG than in the PE for patients with UPG (-3.43 ± 3.27 vs. -0.70 ± 1.26 dB/yr, respectively; p = 0.014). CONCLUSIONS: There were no significant differences in the prevalence of systemic diseases between the UPG and BPG groups. Simultaneously bilaterally progressing patients showed much faster progression rates than those with a unilaterally progressing eye.

Comparison of Risk Factors for Initial Central Scotoma versus Initial Peripheral Scotoma in Normal-tension Glaucoma

PURPOSE: To investigate the risk factors for initial central scotoma (ICS) compared with initial peripheral scotoma (IPS) in normal-tension glaucoma (NTG). METHODS: Fifty-six NTG patients (56 eyes) with an ICS and 103 NTG patients (103 eyes) with an IPS were included. Retrospectively, the differences were assessed between the two groups for baseline characteristics, ocular factors, systemic factors, and lifestyle factors. Also, the mean deviation of visual field was compared between the two groups. RESULTS: Patients from both ICS and IPS groups were of similar age, gender, family history of glaucoma, and follow-up periods. Frequency of disc hemorrhage was significantly higher among patients with ICS than in patients with IPS. Moreover, systemic risk factors such as hypotension, migraine, Raynaud's phenomenon, and snoring were more prevalent in the ICS group than in the IPS group. There were no statistical differences in lifestyle risk factors such as smoking or body mass index. Pattern standard deviation was significantly greater in the ICS group than in the IPS group, but the mean deviation was similar between the two groups. CONCLUSIONS: NTG Patients with ICS and IPS have different profiles of risk factors and clinical characteristics. This suggests that the pattern of initial visual field loss may be useful to identify patients at higher risk of central field loss.

Bilateral Sequential Optic Neuritis in Behcet's Syndrome

No abstract available.

Evaluation of peripapillary choroidal and retinal nerve fiber layer thickness in eyes with tilted optic disc / Avaliação espessura da camada de fibras nervosas peripapilares da retina e coroide em olhos com disco óptico inclinado

Purpose: This study was performed to evaluate the retinal nerve fiber layer (RNFL) and peripapillary choroidal thickness in eyes with tilted optic disc in order to identify characteristic RNFL and peripapillary choroid patterns verified by optical coherence tomography (OCT). Methods: Twenty-nine eyes of 29 patients with tilted optic discs were studied with spectral-domain (SD)-OCT and compared with age and sex-matched control subjects in a prospective design. The imaging of RNFL was performed using circular scans of a diameter of 3.4 mm around the optic disc using OCT. For measurements of peripapillary choroidal thickness, the standar d protocol for RNFL assessment was performed. Results: SD-OCT indicated significantly lower superotemporal (p<0.001), superonasal (p=0.001), and global (p=0.005) RNFL thicknesses in the tilted disc group than those of the control group. Peripapillary choroid was significantly thicker at the site of the elevated rim of eyes with tilted disc (p<0.001). Conclusion: This study demonstrated a clinical characterization of the main tilted disc morphologies that may be helpful in differentiating a tilted disc from other altered disc morphologies. Further studies are recommended to study the comparison between glaucoma and tilted disc groups. .

Objetivo: Avaliar camada de fibras nervosas da retina (RNFL) e a espessura da coroide peripapilar em olhos com disco óptico inclinado a fim de identificar as características da RNFL e os padrões de coroide peripapilar verificados pela tomografia de coerência óptica (OCT). Métodos: Vinte e nove olhos de 29 pacientes com discos ópticos inclinadas foram estudados prospectivamente com OCT de domínio espectral (SD) e comparados com controles pareados por sexo e idade. As imagens da RNFL foi obtidas por meio de varreduras circulares com um diâmetro de 3,4 mm em torno do disco óptico usando OCT. Para as medições de espessura da coroide peripapilar, o protocolo padrão para avaliação da RNFL foi realizado. Resultados: O OCT SD indicou diminuição das espessuras significativas da RNFL superotemporal (p<0,001), superonasal (p=0,001), e global (p=0,005) no grupo disco inclinado em relação aos do grupo controle. A coroide peripapilar foi significativamente mais espessa no local da borda elevada dos olhos com disco inclinado (p<0,001). Conclusões: Este estudo demonstrou que a caracterização clínica das principais morfologias disco inclinado pode ser útil na diferenciação entre um disco inclinado de outras alterações morfológicas de disco. Seria importante a comparação entre grupos com glaucoma e com discos inclinados, estudos futuros. .