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Article in English | WPRIM | ID: wpr-197515


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.

Aged , Disease Progression , Female , Glaucoma, Open-Angle/diagnosis , Gonioscopy , Humans , Intraocular Pressure , Low Tension Glaucoma/diagnosis , Male , Middle Aged , Nerve Fibers/pathology , Optic Disk/pathology , Optic Nerve Diseases/diagnosis , Photography/standards , Retinal Ganglion Cells/pathology , Retrospective Studies , Tomography, Optical Coherence , Tonometry, Ocular , Vision Disorders/diagnosis , Visual Field Tests/standards , Visual Fields
Rev. Soc. Colomb. Oftalmol ; 48(1): 21-31, 2015. tab.
Article in Spanish | LILACS, COLNAL | ID: biblio-916733


Objetivo: determinar la prevalencia de las diferentes características morfológicas asociadas al glaucoma en el nervio óptico y retina peripapilar de pacientes con diagnóstico de glaucoma primario de ángulo abierto. Métodos: se analizaron 374 fotografías del polo posterior de pacientes con glaucoma primario de ángulo abierto, registrando presencia o ausencia de adelgazamiento del anillo neural, hemorragias peripapilares, atrofia peripapilar alfa o beta, exposición de lámina cribosa, vasos denudados, vasos en bayoneta, escotadura en la excavación, medición del diámetro vertical y horizontal de la papila y de la excavación, área del disco óptico y de la excavación; los cuales se correlacionaron con datos de la historia clínica como edad, sexo, comorbilidades, presión intraocular, tratamiento, número de medicamentos en uso, historia de cirugía intraocular. Resultados: los cambios más frecuentemente asociado a glaucoma fueron adelgazamiento del anillo neuroretinal (59.4%), exposición de la lámina cribosa, (67.6%), atrofia peripapilar y vasos en bayoneta (35.3%). El promedio del diámetro vertical del disco fue 1.9 mm ± 0.2 y el diámetro horizontal del disco fue 1.7 mm ± 0.1. Conclusiones: la valoración de los cambios asociados a glaucoma por medio de fotografía del disco óptico permite realizar un registro detallado y sistemático de cada una de las características y su documentación para seguimiento en el tiempo.

Objetive: to determine the prevalence of optic nerve and peripapillar retina characteristics in patients diagnosed with primary open-angle glaucoma. Methods: 374 posterior pole photographs of patients with primary open-angle glaucoma were analyzed recording presence or absence of neuroretinal rim thinning, peripapillary hemorrhages, alpha or beta parapapillary atrophy, baring of blood vessels, vessel bayoneting, neuroretinal rim notching, vertical and horizontal disc and cup diameter, disc and cup area. These date were correlated with medical records including age, sex, comorbidities, intraocular pressure, treatment and intraocular surgery. Results: the most common glaucoma associated changes were neuroretinal rim thinning (59.4 %), exposure of the lamina cribrosa ( 67.6 % ), peripapillary atrophy and vessels bayoneting ( 35.3%). The disc vertical diameter was 1.9 ± 0.2 mm and horizontal disc diameter 1.7 ± 0.1 mm. Conclusions: glaucoma associated changes assessment using optic disc photography allows a detailed and systematic recording on each characteristic and its follow up over the time.

Glaucoma, Open-Angle/epidemiology , Optic Nerve Diseases/diagnosis , Optic Nerve/physiopathology , Retina/physiopathology
Article in English | WPRIM | ID: wpr-229266


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.

Age Distribution , Cross-Sectional Studies , Female , Glaucoma/diagnosis , Humans , Intraocular Pressure , Male , Morbidity/trends , Optic Disk/pathology , Optic Nerve Diseases/diagnosis , Population Surveillance , Reference Values , Republic of Korea/epidemiology , Retrospective Studies , Sex Distribution , Tonometry, Ocular
Arq. bras. oftalmol ; 77(6): 403-410, Nov-Dec/2014. graf
Article in English | LILACS | ID: lil-735806


Pattern electroretinography is used to assess the function of the inner retinal layers, particularly the retinal ganglion cell layer, using a reversing checkerboard or grating pattern that maintains a constant overall mean luminance over time. A normal transient response comprises a positive component of the wave (P50) followed by a longer negative component of the wave (N95). Glaucomatous optic neuropathy causes progressive loss of retinal ganglion cells, potentially detectable as abnormalities on examination, particularly in the N95 component. Therefore, pattern electroretinography may be useful in the diagnosis and evaluation of glaucoma. The present article is an updated review of published data regarding the use of pattern electroretinography for the detection of glaucoma-induced retinal changes.

O eletroretinograma de padrão reverso é utilizado para avaliar a função das camadas internas da retina, particularmente a camada de células ganglionares retinianas, utilizando um estímulo em xadrez ou barras alternantes, mantendo constante o nível de contraste total. A resposta transiente normal é constituída por uma onda positiva (P50) seguida de uma onda maior negativa (N95). A neuropatia óptica glaucomatosa causa perda progressiva das células ganglionares da retina, detectável como anormalidades no exame, especialmente na onda N95. Por isso, o eletroretinograma de padrão reverso pode ser útil no diagnóstico e seguimento de pacientes glaucomatosos. Este artigo é uma revisão atualizada dos dados publicados a respeito da capacidade do eletroretinograma de padrão reverso em detectar alterações retinianas induzidas pelo glaucoma.

Humans , Electroretinography/methods , Glaucoma/diagnosis , Glaucoma/physiopathology , Optic Nerve Diseases/diagnosis , Optic Nerve Diseases/physiopathology , Optic Nerve/physiopathology , Visual Fields/physiology
Article in English | WPRIM | ID: wpr-30315


PURPOSE: To compare the thickness of the lamina cribrosa (LC) and vascular factors of early normal-tension glaucoma (NTG) patients with high and low intraocular pressure (IOP) that are expected to be associated with the development of glaucoma. METHODS: Seventy-one Korean NTG patients with low IOP (the highest IOP 15 mmHg, 31 patients) were included in this study. The thickness of LC and vascular factors were compared. The thickness of the LC was measured using the enhanced depth imaging method with spectral domain optical coherence tomography (Heidelberg Spectralis). RESULTS: The mean thickness of the central LC was 190.0 +/- 19.2 microm in the low IOP group and 197.8 +/- 23.6 microm in the high IOP group, but there was no statistical significant difference between the two groups (p > 0.05). The prevalence of self-reported Raynaud phenomenon was significantly higher in the low IOP group (33.0%) than the high IOP group (10.3%, p = 0.04). CONCLUSIONS: The laminar thickness did not significantly differ between the high and low IOP groups. However, the prevalence of Raynaud phenomenon was higher in the low IOP groups. These results suggest that the development of glaucoma with low IOP patients may be more influenced by peripheral vasospasm, such as Raynaud phenomenon, rather than laminar thickness in NTG.

Aged , Cross-Sectional Studies , Female , Humans , Intraocular Pressure , Low Tension Glaucoma/diagnosis , Male , Middle Aged , Nerve Fibers/pathology , Optic Disk/pathology , Optic Nerve Diseases/diagnosis , Raynaud Disease/diagnosis , Retinal Ganglion Cells/pathology , Tomography, Optical Coherence , Tonometry, Ocular , Vision Disorders/diagnosis , Visual Fields
Rev. cuba. oftalmol ; 26(2): 345-351, mayo.-ago. 2013.
Article in Spanish | LILACS | ID: lil-695044


Introducción: el diagnóstico de las anomalías congénitas excavadas del nervio óptico se ha beneficiado con la introducción y desarrollo de las técnicas imagenológicas; particularmente en los casos atípicos o con alteraciones oculares asociadas, donde el examen clínico no puede ser concluyente. Caso clínico: se presenta un paciente con una anomalía congénita del nervio óptico y se discuten las características clínico-imagenológicas que sustentan su diagnóstico diferencial. Se recomienda la evaluación conjunta, por parte de oftalmólogos y radiólogos, de pacientes con estas anomalías; sobre todo en aquellos donde las presentaciones fundoscópicas no son específicas. Conclusiones: el diagnóstico nosológico correcto garantiza una adecuada orientación sobre alteraciones sistémicas relacionadas y patrones de herencia, si los hay

Introducción: the diagnosis of excavated congenital anomalies of the optic nerve has benefitted from the introduction and development of radiological techniques, mainly in atypical cases or those with others related ocular disorders, where the clinical exam is not conclusive. Clincal case: Here is a patient with a congenital optic nerve anomaly. The clinical and radiological characteristics that explain the differential diagnosis of this case were discussed. Emphasis was made on the fact that patients with these anomalies and no specific fundus features must be evaluated by both ophthalmologists and radiologists. Conclusions: the right nosological diagnosis assures the appropriate orientation towards others related systemic associations and inheritance patterns, if any

Humans , Male , Child, Preschool , Coloboma , Optic Nerve Diseases/congenital , Optic Nerve Diseases/diagnosis , Magnetic Resonance Imaging/methods , Tomography, X-Ray Computed/methods
Clinics ; 67(11): 1327-1334, Nov. 2012. ilus, tab
Article in English | LILACS | ID: lil-656726


Although the diagnosis of Graves' orbitopathy is primarily made clinically based on laboratory tests indicative of thyroid dysfunction and autoimmunity, imaging studies, such as computed tomography, magnetic resonance imaging, ultrasound and color Doppler imaging, play an important role both in the diagnosis and follow-up after clinical or surgical treatment of the disease. Imaging studies can be used to evaluate morphological abnormalities of the orbital structures during the diagnostic workup when a differential diagnosis versus other orbital diseases is needed. Imaging may also be useful to distinguish the inflammatory early stage from the inactive stage of the disease. Finally, imaging studies can be of great help in identifying patients prone to develop dysthyroid optic neuropathy and therefore enabling the timely diagnosis and treatment of the condition, avoiding permanent visual loss. In this paper, we review the imaging modalities that aid in the diagnosis and management of Graves' orbitopathy, with special emphasis on the diagnosis of optic nerve dysfunction in this condition.

Humans , Diagnostic Imaging/methods , Graves Disease/diagnosis , Optic Nerve Diseases/diagnosis
Article in English | WPRIM | ID: wpr-94390


A 32-year-old man with blurred vision in the right eye and headache presented with anterior uveitis, an intraocular pressure (IOP) of 60 mmHg, an open angle, no visual field defects, and normal optic nerve. He had a history of five previous similar attacks. In each of the previous instances, his anterior uveitis and high IOP were controlled with antiglaucoma medications and topical steroids. However, at the fifth attack, his optic disc was pale and a superior paracentral visual field defect was shown. Brain magnetic resonance image studies were normal. This case represents that a recurrent Posner-Schlossman syndrome (PSS)-induced optic disc atrophy likely due to ocular ischemia caused by a recurrent, high IOP. Although PSS is a self-limiting syndrome, we should manage high IOP and prevent ischemia of the optic nerve head by treating with ocular antihypertensive medications.

Atrophy/diagnosis , Diagnosis, Differential , Glaucoma, Open-Angle/complications , Humans , Intraocular Pressure , Male , Optic Disk/pathology , Optic Nerve Diseases/diagnosis , Syndrome , Young Adult
Arq. bras. oftalmol ; 74(3): 222-226, May-June 2011. ilus
Article in English | LILACS | ID: lil-598321


The pattern electroretinogram is an electrophysiological test that assesses the function of inner retinal layers, particularly the ganglion cells layer of retina, using a reversing checkerboard or grating pattern that produces no change in average luminance over time. The normal pattern electroretinogram is composed of a proeminent positive component (P50) and a large later negative component (N95). Since structural damage that compromises the retinal ganglion cell layer can lead to pattern electroretinogram changes, particularly in the N95 amplitude, the test can be useful in the treatment of a number of anterior visual pathway diseases. In this article, we review the methods for recording pattern electroretinogram and its usefulness in the diagnosis and management of diseases including inflammatory, hereditary, ischemic and compressive lesions of the anterior visual pathway.

O eletroretinograma de padrão reverso é um teste eletrofisiológico que avalia a função das camadas internas da retina, especialmente a camada de células ganglionares, através de um estímulo em xadrez ou em barras que não apresenta variação na luminância do estímulo. É composto de um componente positivo (P50) e um componente negativo (N95) tardio. Uma vez que lesões estruturais às células ganglionares da reitna podem levar a alterações no eletroretinograma de padrão reverso, especialmente na amplitude da onda N95, o teste pode ser útil no tratamento de várias doenças da via óptica anterior. Neste artigo revisamos os métodos de obtenção do eletroretinograma de padrão reverso e a sua utilidade no diagnóstico e acompanhamento de doenças incluindo lesões inflamatórias, hereditárias, isquemicas e compressivas na via óptica anterior.

Humans , Electroretinography/methods , Optic Nerve Diseases/diagnosis , Visual Pathways/physiopathology , Optic Nerve Diseases/physiopathology
Article in English | WPRIM | ID: wpr-210239


PURPOSE: To assess the inter-device agreement of peripapillary retinal nerve fiber layer (RNFL) thickness measurements by 2 spectral domain Cirrus HD optical coherence tomography (OCT) devices in healthy Korean subjects. METHODS: Eleven eyes of 11 healthy volunteers were enrolled in the present study. Each eye was scanned with the Optic Disc Cube 200 x 200 scan of 2 Cirrus HD OCT devices for peripapillary RNFL thickness calculation. The inter-device agreements of the 2 Cirrus HD OCTs for average, quadrant, and clock-hour RNFL thickness values were determined with Wilcoxon signed rank test, Friedman test, Cronbach's alpha (alpha), intraclass correlation coefficient (ICC), coefficient of variation (COV), and Bland-Altman plot. RESULTS: The mean age of the participants was 25.82 +/- 3.28 years and all had a 0.00 logarithm of the minimum angle of resolution of best-corrected visual acuity. The signal strengths of scans from the 2 Cirrus HD OCT were not significantly different (p = 0.317). The inter-device agreement of average RNFL thickness was excellent (alpha, 0.940; ICC, 0.945; COV, 2.45 +/- 1.52%). However, the agreement of nasal quadrant RNFL thickness was not very good (alpha, 0.715; ICC, 0.716; COV, 5.72 +/- 4.64%). Additionally, on the Bland-Atman plot, the extent of agreement of the 2 Cirrus HD OCTs for RNFL thickness was variable according to scanned sectors. CONCLUSIONS: The inter-device agreement of 2 spectral domain Cirrus HD OCT devices for peripapillary RNFL thickness measurements was generally excellent but variable according to the scanned area. Thus, physicians should consider this fact before judging a change of RNFL thicknesses if they were measured by different OCT devices.

Adult , Algorithms , Female , Humans , Male , Observer Variation , Optic Nerve Diseases/diagnosis , Retinal Ganglion Cells/pathology , Tomography, Optical Coherence/methods , Young Adult
Article in English | WPRIM | ID: wpr-221043


A 59-year-old woman was referred to our clinic for a glaucoma evaluation. The visual acuity and intraocular pressure were normal in both eyes. However, red-free fundus photography in the left eye showed a superotemporal wedge-shaped retinal nerve fiber layer defect, and visual field testing showed a corresponding partial arcuate scotoma. In an optical coherence tomography examination, the macula was flat, but an arcuate-shaped peripapillary retinoschisis was found. Further, the retinoschisis seemed to be connected with a superotemporal optic pit shown in a disc photograph. After 3 months of a topical prostaglandin analogue medication, the intraocular pressure in the retinoschisis eye was lowered from 14 to 10 mmHg and the peripapillary retinoschisis was almost resolved. We report a rare case of an optic disc pit with peripapillary retinoschisis presenting as a localized retinal nerve fiber layer defect.

Female , Humans , Middle Aged , Nerve Fibers/pathology , Optic Disk/abnormalities , Optic Nerve Diseases/diagnosis , Retinal Ganglion Cells/pathology , Retinoschisis/diagnosis , Tomography, Optical Coherence
Arq. bras. oftalmol ; 73(4): 320-322, July-Aug. 2010. ilus
Article in English | LILACS | ID: lil-560602


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.

Adult , Female , Humans , Male , Middle Aged , Young Adult , Diagnostic Techniques, Ophthalmological/instrumentation , Glaucoma/classification , Optic Disk/anatomy & histology , Optic Nerve Diseases/diagnosis , Brazil , Cross-Sectional Studies , Glaucoma/diagnosis , Observer Variation , Ophthalmology/instrumentation , Photography , Reproducibility of Results , Sensitivity and Specificity
Arq. bras. oftalmol ; 73(4): 354-357, July-Aug. 2010. ilus, tab
Article in English | LILACS | ID: lil-560610


PURPOSE: To determine factors associated with the test-retest variability of optic nerve head (ONH) topography measurements with confocal scanning laser ophthalmoscopy (CSLO) in newly diagnosed glaucomatous patients. METHODS: Consecutive patients with newly diagnosed primary open-angle glaucoma were prospectively enrolled. Patients presenting with any ocular disease other than glaucoma were excluded. All patients underwent CSLO using the Heidelberg Retina Tomograph III (HRT-III) in one randomly selected eye (three consecutive scans; performed by the same examiner). For each Heidelberg Retina Tomograph III parameter, repeatability was assessed using within subject standard deviation (Sw) and coefficient of variation (CVw), repeatability coefficient (RC) and intraclass correlation coefficient (ICC). Scatter plots and regression lines were constructed to identify which factors influenced test-retest measurement variability. RESULTS: A total of 32 patients were included (mean age, 65.4 ± 13.8 years). Most patients were female (65 percent) and white (50 percent). Among all Heidelberg Retina Tomograph III parameters evaluated, rim area and mean cup depth had the best measurement repeatability. Vertical cup-to-disc ratio (CDR, as determined by optic disc stereophotograph examination) was significantly associated (R²=0.21, p<0.01) with test-retest measurement variability. Eyes with larger CDR showed less variable measurements. Other factors, including age, disc area, central corneal thickness and intraocular pressure were not significant (p>0.14). CONCLUSION: Heidelberg Retina Tomograph III showed good test-retest repeatability for all ONH topographic measurements, mainly for rim area and mean cup depth. Test-retest repeatability seemed to improve with increasing CDR. These findings suggest that HRT-III topographic measurements should be cautiously interpreted when evaluating longitudinally glaucoma patients with early structural damage (small CDR).

OBJETIVO: Determinar os fatores associados à variabilidade (teste-reteste) das medidas topográficas da cabeça do nervo óptico (CNO) utilizando a oftalmoscopia confocal de varredura a laser (CSLO) em pacientes com glaucoma recém-diagnosticados. MÉTODOS: Neste estudo, pacientes com glaucoma primário de ângulo aberto recém-diagnosticados foram prospectivamente incluídos. Aqueles que apresentassem outras doenças oculares (exceto glaucoma) foram excluídos. Todos os pacientes incluídos no estudo foram submetidos à CSLO usando o aparelho Heidelberg Retina Tomograph III (HRT-III) em um olho aleatoriamente selecionado (três exames consecutivos realizados pelo mesmo examinador). Para cada parâmetro do Heidelberg Retina Tomograph III, a repetibilidade foi avaliada através dos seguintes indicadores: desvio padrão (DP) e coeficiente de variação (CV) individual, coeficiente de repetibilidade (CR) e coeficiente de correlação intraclasse (CCI). Diagramas de dispersão e linhas de regressão foram construídos para identificar quais fatores poderiam influenciar a variabilidade das medidas. RESULTADOS: Trinta e dois pacientes foram incluídos no estudo (idade média, 65,4 ± 13,8 anos). A maior parte era composta por mulheres (65 por cento) e pacientes brancos (50 por cento). Dentre os parâmetros de Heidelberg Retina Tomograph III avaliados, a área da rima e a profundidade média da escavação apresentaram os melhores valores de repetibilidade. A relação escavação/disco (E/D) vertical (baseada na análise de estereofotografia do disco óptico), foi significativamente associada (R²=0.21, p<0.01) com a variabilidade teste-reteste. Pacientes com relação E/D maiores apresentaram medidas menos variáveis. Outros fatores como idade, área do disco, espessura corneana central e pressão intraocular não foram significativas (p>0,14). CONCLUSÃO: O Heidelberg Retina Tomograph III mostrou boa repetibilidade (teste-reteste) para todos os parâmetros topográficos da CNO avaliados, principalmente em relação à área da rima e à profundidade média da escavação. A repetibilidade teste-reteste apresentou melhores resultados com o aumento da relação E/D. Esses achados sugerem que as medidas topográficas do Heidelberg Retina Tomograph III devem ser interpretadas com cautela quando avaliarmos longitudinalmente pacientes glaucomatosos com dano estrutural inicial (relação E/D menor).

Aged , Female , Humans , Male , Middle Aged , Glaucoma, Open-Angle/diagnosis , Ophthalmoscopy/methods , Optic Disk/anatomy & histology , Tomography/methods , Age Factors , Cross-Sectional Studies , Microscopy, Confocal , Ophthalmoscopes/standards , Optic Nerve Diseases/diagnosis , Reproducibility of Results , Sex Factors
Article in English | WPRIM | ID: wpr-53666


A 44-year-old woman with Castleman disease presented with acute visual loss in the left eye. A full ophthalmologic examination and imaging were performed. Visual acuity was 20/20 in the right eye and 20/100 in the left eye. Total dyschromatopsia, a relative afferent pupillary defect, and a cecocentral scotoma were observed in the left eye. Mild disc edema, without leaking during fluorescein angiography, was also observed. Magnetic resonance imaging revealed a small cystic epidermoid-like lesion in the right prepontine and suprasellar cistern. Her visual acuity did not improve and deteriorated to 20/200 in the left eye at 22 months after the initial visual loss. Optic neuropathy may rarely be associated with Castleman disease and suggests a poor prognosis.

Adult , Diagnosis, Differential , Disease Progression , Female , Fluorescein Angiography , Fundus Oculi , Castleman Disease/complications , Humans , Magnetic Resonance Imaging , Optic Nerve Diseases/diagnosis , Tomography, Optical Coherence , Visual Acuity , Visual Field Tests , Visual Fields
Indian J Ophthalmol ; 2009 Sept; 57(5): 361-364
Article in English | IMSEAR | ID: sea-135978


Background: Assessment of optic disc size is an important component of optic nerve head examination. Agreement between different methods of disc size measurements is not very good. Purpose: To assess the agreement between the disc size assessed by Heidelberg retina tomograph (HRT) and stereobiomicroscopy with a 90 diopter (D) lens. To report the clinical (measured by biomicroscopy) disc diameters of small, average and large optic discs categorized by HRT disc areas. Setting and Design: Observational study of subjects examined in the glaucoma clinic of a tertiary eye institute. Materials and Methods: Seventy-five eyes of 75 glaucoma subjects were studied. Disc diameter was measured using stereobiomicroscopy and HRT. The agreement between the two sets of measurements was assessed by intraclass correlation coefficient (ICC). Discs were classified into small (<1.6 mm2), average (1.6-2.6 mm2) and large (>2.6 mm2) depending on cutoffs provided by the manufacturers of HRT. The means (95% CI) of the corresponding vertical disc diameter in these groups were assessed. Statistical Analysis: ICC, Bland and Altman plots. Results: ICC for measurements of clinical and HRT horizontal disc diameter was 0.518 and for vertical disc diameter measurement was 0.487. The mean difference between the clinical and HRT measurements as analyzed by the Bland and Altman plot was 0.17 (95% CI, 0.13- 0.47) for horizontal and 0.22 (95% CI, 0.11- 0.54) for vertical disc diameter. Of the 75 eyes, 3 eyes had small discs, 54 average and 18 large discs. The mean clinical vertical disc diameter for small discs was 1.55 mm (95% CI, 1.2-1.7), for average discs was 1.91 mm (95% CI, 1.87-1.96) and for large discs was 2.15 mm (95% CI, 2.03–2.27). Conclusion: The agreement between clinical and HRT disc diameter measurements is moderate. Disc diameter measurement on stereobiomicroscopy can be used to categorize discs into small, average and large discs.

Diagnostic Techniques, Ophthalmological , Female , Glaucoma/complications , Glaucoma/diagnosis , Humans , Male , Middle Aged , Observer Variation , Optic Disk/pathology , Optic Nerve Diseases/diagnosis , Optic Nerve Diseases/etiology , Reproducibility of Results , Retrospective Studies , Severity of Illness Index , Tomography/methods
Cir. & cir ; 77(4): 309-312, jul.-ago. 2009. ilus
Article in Spanish | LILACS | ID: lil-566484


Introducción: La neuropatía óptica traumática puede ser difícil de diagnosticar en un primer contacto, por la ausencia de cambios en el disco óptico o por la coexistencia de lesiones más aparentes. Aunque existen datos funcionales que la sugieren, la falta de un parámetro contralateral de comparación puede limitar la detección. El objetivo fue analizar el caso de un paciente con neuropatía óptica traumática con afección bilateral asimétrica, para hacer énfasis en la necesidad de evaluar funcionalmente los ojos lesionados. Caso clínico: Hombre de 34 años de edad con traumatismo craneoencefálico severo, pérdida del estado de alerta y fractura facial tipo Lefort III por accidente automovilístico. A las 72 horas del accidente únicamente percibía luz y tenía un defecto pupilar aferente en el ojo izquierdo; el ojo derecho tenía deficiencia visual, no justificada por alteraciones del segmento anterior. El tratamiento se enfocó al ojo izquierdo, pero durante el seguimiento se identificó tardíamente afección del ojo derecho. Se analizó la evolución del paciente y las causas que limitaron la detección temprana de la neuropatía traumática en el ojo derecho. Conclusiones: La neuropatía óptica traumática debe buscarse mediante la evaluación funcional en todos los ojos lesionados. La ausencia de alteraciones en el fondo del ojo no la descarta, particularmente si existe deficiencia visual. Es necesario identificar los pacientes con pupila positiva durante la evaluación inicial y referirlos oportunamente al especialista, quien identificará los casos atípicos e implementará tempranamente el tratamiento.

BACKGROUND: Diagnosis of traumatic optic neuropathy is difficult during primary care as a result of the absence of optic disk changes or coexisting injuries that may be more apparent. Although there are functional signs that suggest its presence, the lack of a comparison parameter may further prevent its detection. A case of bilateral traumatic optic neuropathy is analyzed to emphasize the need for functional evaluation in the injured eye. CLINICAL CASE: A 34-year-old male presented with severe head trauma, loss of consciousness and type III Lefort facial fracture as a result of a vehicular accident. Seventy two hours after the accident, the left eye had only light perception and an afferent pupillary defect. The right eye had visual deficiency not explained by anterior segment injuries. Therapy was aimed at the left eye and, during follow-up, involvement of the right eye was identified very late. The patient's evolution is analyzed, as well as the causes that prevented early detection of traumatic optic neuropathy in the right eye. CONCLUSIONS: Functional evaluation must be used to search for traumatic optic neuropathy in every injured eye. The absence of ocular fundus abnormalities does not rule out the disease, especially when visual deficiency exists. Detection of patients with a positive pupil during initial evaluation of trauma is required in order to refer the patient in a timely manner to the ophthalmologist. The specialist should identify atypical cases and therapy should be initiated as early as possible.

Humans , Male , Adult , Optic Nerve Diseases/etiology , Optic Nerve Injuries/complications , Optic Nerve Diseases/diagnosis
Indian J Ophthalmol ; 2009 May-Jun; 57(3): 207-11
Article in English | IMSEAR | ID: sea-72289


Purpose: The aim of this study was to compare the Humphrey MATRIX visual field (frequency doubling technology threshold) and Swedish interactive threshold algorithm (SITA) standard strategy white on white perimetry in detecting glaucomatous visual field loss. Material and Methods: Twenty-eight adult subjects, diagnosed to have glaucoma at a tertiary eye care hospital, who fulfilled the inclusion criteria, were included in this prospective study. All subjects underwent a complete ophthalmic examination. Subjects with glaucomatous optic disc changes underwent repeat perimetric examination on the same day with the Humphrey visual field analyzer (HFA II) and Humphrey MATRIX, the order of testing being random. Only reliable fields, where the HFA results corresponded to the disc changes were considered for analysis. A cumulative defect depth in each hemifield in both HFA and MATRIX reports was calculated. Results: Thirty-seven eyes of 24 subjects had reliable fields corresponding to optic disc changes. The mean age of the subjects was 56 +/- 12 years. There were 12 males and 12 females. The test duration was significantly less on the MATRIX, mean difference in test duration was -81 +/- 81.3 sec ( p p = 0.55, p = 0.64 respectively) and a positive correlation coefficient of 0.63 and 0.72 respectively. Poor agreement was found with the glaucoma hemifield test. Conclusion: The Humphrey MATRIX takes less time in performing the test than SITA Standard and shows good correlation for mean deviation and pattern standard deviation. However, the glaucoma hemifield test showed poor agreement. The Humphrey MATRIX diagnoses were similar to established perimetric standards.

Adult , Algorithms , Female , Glaucoma, Open-Angle/diagnosis , Humans , Male , Middle Aged , Optic Nerve Diseases/diagnosis , Vision Disorders/diagnosis , Visual Field Tests/methods , Visual Fields
Rev. bras. oftalmol ; 68(1): 48-52, Jan.-Feb. 2009. ilus, graf
Article in English | LILACS | ID: lil-508925


PURPOSE: To report abnormalities of retinal nerve fiber layer (RNFL) thickness using Stratus - optical coherence tomography (OCT) in two patients with optic tract lesions. METHODS: Two patients with long standing homonymous hemianopia from optic tract lesions were submitted to a complete neuro-ophthalmic evaluation and to Stratus -optical coherence tomography examination. RESULTS: Both patients revealed diffuse loss of the RNFL at Stratus - OCT in both eyes. In the eyes with the temporal hemianopia, RFNL loss was diffuse but predominantly in the nasal and temporal areas of the optic disc, the classic pattern of band atrophy of the optic nerve. In the eyes with nasal hemianopia RNFL loss could be documented in the superior and inferior quadrants of the optic disc. RNFL loss correlated well with visual field loss and the expected pattern of RNFL loss in optic tract lesions. CONCLUSION: Stratus-Optical coherence tomography can provide useful information in the diagnosis of optic tract lesions by identifying the characteristic pattern of RNFL loss that occurs in both eyes in this condition.

OBJETIVO: Relatar alterações na camada de fibras nervosas retiniana (CFNR) com o uso da tomografia por coerência óptica (TCO) Stratus em pacientes com lesões do trato óptico. MÉTODOS: Dois pacientes com hemianopsia homônima de longa duração decorrente de lesões do trato óptico foram submetidos a avaliação neuroftalmológica completa e tomografia por coerência óptica Stratus. RESULTADOS: Ambos pacientes demonstraram redução difusa da CFNR nos dois olhos. Nos olhos com a hemianopsia temoporal, a perda da CFNR foi difusa mas com predomínio nas áreas nasal e temporal do disco óptico, um padrão clássico da atrofia em banda do nervo óptico. Nos olhos com hemianopsia nasal observou-se perda da CFNR nos quadrantes superior e inferior do disco óptico. A perda da CFNR se correlacionou com o defeito de campo visual e com o padrão esperado de perda da CFNR nas lesões do trato óptico. CONCLUSÃO: A tomografia por coerência óptica - Stratus pode fornecer informação útil no diagnóstico das lesões do trato óptico ao identificar o padrão característico de perda da CFNR que ocorre em ambos os olhos nesta condição.

Humans , Optic Disk/pathology , Optic Nerve Diseases/diagnosis , Retinal Neurons/pathology , Tomography, Optical Coherence , Cross-Sectional Studies , Optic Disk , Reproducibility of Results , Retina/pathology , Retinal Ganglion Cells/pathology