Caracterización de indicadores de detección de glaucoma con los equipos OCT Spectralis y campímetro Humphrey II en pacientes altos miopes y altos miopes glaucomatosos del Hospital Clínico Universidad de Chile / Characterization of glaucoma detection indicators with OCT Spectralis equipment and Humphrey II campimeter in patients with high myopia and high myopia glaucomatous at the Hospital Clínico Universidad de Chile

Purpose: Characterize and describe glaucoma index parameters of the results of visual exams, Optical Coherence Tomography and Visual Field, in high myopic subjects with and without the pathology. Method: Cross sectional and observational study of 39 eyes, 15 high myopic with glaucoma y 24 high myopic without it. Visual Field (VF) were performed, where the global index between both groups were analyzed; Mean Deviation (MD), Model Standard Deviation (MSD) and Visual Field Index (VFI), beside Optical Coherence Tomography (OCT), in which the thickness of the ganglion cells layer (GCL) inside 3 central mm was compared. Results: The results were satisfactory, demonstrating different characteristics between the high myopic group with glaucoma and without it, both in VF and OCT exams. It was obtained in the VF analysis difference in average MD of -4,92 dB + 3,71 (p<0,05); difference in average DSM of 2,01 dB + 2,85 (p>0,05) and VFI with Friedman Test 10,29 (p>0,05). The statistical OCT analysis, when comparing GCL, observed that the Temporary sector (T) had a statistically significant decrease (p<0,05). Conclusions: To continue studies in this investigative line, can expand the knowledge in this area, mainly in the study of the GCL. (AU)

Vision and the Nobel Prize / A visão e Prêmio Nobel

ABSTRACT The Nobel Prize is the world's foremost honor for scientific advances in medicine and other areas. Founded by Alfred Nobel, the prizes have been awarded annually since 1901. We reviewed the literature on persons who have won or competed for this prize in subjects related to vision and ophthalmology. The topics were divided into vision physiology, diagnostic and therapeutic methods, disease mechanism, and miscellaneous categories. Allvar Gullstrand is the only ophthalmologist to win a Nobel Prize; he is also the only one to receive it for work in ophthalmology. Other ophthalmologists that have been nominated were Hjalmar Schiötz (tonometer), Karl Koller (topical anesthesia), and Jules Gonin (retinal detachment). Other scientists have won the prize for eye-related research: Ragnar Granit, Haldan Hartline and George Wald (chemistry and physiology of vision), and David Hubel and Torsten Wiesel (processing in the visual system). Peter Medawar is the only person born in Brazil to have won the Nobel Prize.

RESUMO O Prêmio Nobel é a principal honraria do mundo para avanços científicos em medicina e outras áreas. Fundada por Alfred Nobel, os prêmios são concedidos anualmente desde 1901. Revisamos a literatura sobre pessoas que ganharam ou competiram por esse prêmio em assuntos relacionados à visão e oftalmologia. Os tópicos foram divididos em fisiologia da visão, métodos diagnósticos e terapêuticos, mecanismo de doenças e variados. Allvar Gullstrand não é o único oftalmologista a ganhar um Nobel, porém é o único a recebê-lo por contribuições na oftalmologia. Outros oftalmologistas foram nomeados: Hjalmar Schiötz (tonometro), Karl Koller (anestesia tópica) e Jules Gonin (descolamento da retina). Outros cientistas ganharam o prêmio com pesquisas relacionadas à visão: Ragnar Granit, Haldan Hartline e George Wald (química e fisiologia da visão); David Hubel e Torsten Wiesel (processamento no sistema visual). Peter Medawar é a única pessoa que nasceu no Brasil a ganhar o prêmio.

Concordancia de la citología de impresión y la patología con nevus conjuntivales en la Clínica Oftalmológica de Cartagena / Concordance between impression cytology and pathology evaluation in patients with conjunctival nevus at Clínica Oftalmológica de Cartagena

Objetivos: evaluar la concordancia entre la citología de impresión y el estudio de anatomía patológica en pacientes con nevus conjuntivales que consultaron al Departamento de Córnea de la Clínica Oftalmológica de Cartagena. Diseño del estudio: estudio de concordancia. Métodos: se tomaron 48 ojos de 44 pacientes con hiper o hipopigmentación conjuntival a los que se le realizó citología de impresión y estudio histopatológico comparándose los resultados. Resultados: durante Junio 2011 a Junio 2012 se incluyeron 48 pacientes con sospecha de nevus conjuntivales a los cuales se les realizó citología de impresión y estudio histopatológico. Tuvo más prevalencia el sexo femenino con 68.75%. La edad promedio fué de 34.5 años. Las lesiones encontradas en OD fueron el 52.08%. El 60.42% presentaron pigmento leve o moderado seguido de un 35.42% de pacientes con abundante pigmentación. La localización más común de la lesión fue la conjuntiva bulbar con 93.75%. La citología de impresión resultó positiva para nevus en el 89.58% mientras que la patología arrojó resultados de nevus sub-epitelial en un 35.42%, seguido de nevus compuesto y de unión en el 33.33 y 20.83% respectivamente, y ausencia de nevus en el 10.42%. La sensibilidad de la citología de impresión fue de 93.02% con una especificidad del 40%. Conclusiones: la citología de impresión es un método altamente sensible para la detección de nevus conjuntivales y puede ser utilizado como prueba de tamizaje.

Objectives: to evaluate the concordancebetween impression cytology and pathology evaluation in patients with conjunctival nevus attending Cornea Clinic at Clinica Oftalmológica de Cartagena. Study Design: concordance study Methods: We evaluated 48 eyes from 44 patients with conjunctival hyper or hypopigmentation whom underwent impression cytology and histopathology assessment to find concordance between two methods. Results: during June 2011 to June 2012, we included 48 patients with suspected conjunctival nevus whom underwent impression cytology and histopathology study. Female prevalence was 68.75%. Average age was 34.5 years. Lesions were found in right eye in 52.08% of patients. 60.42% had moderate or mild pigment followed by 35.42% with abundant pigment. The most common location of injury was the bulbar conjunctiva with 93.75%. Impression cytology was positive for nevus in 89.58%, while pathology studies showed subepithelial nevus in 35.42% of cases, followed by compound nevus and union nevus with 33.33% and 20.83% respectively. 10.42% of patients showed absence of nevus. Sensitivity of impression cytology was 93.02% while specificity of the test achieved 40%. Conclusions: impression cytology is a highly sensitive method to detect conjunctival nevi and can be used as a screening test.

Angle imaging: Advances and challenges.

Primary angle closure glaucoma (PACG) is a major form of glaucoma in large populous countries in East and South Asia. The high visual morbidity from PACG is related to the destructive nature of the asymptomatic form of the disease. Early detection of anatomically narrow angles is important and the subsequent prevention of visual loss from PACG depends on an accurate assessment of the anterior chamber angle (ACA). This review paper discusses the advantages and limitations of newer ACA imaging technologies, namely ultrasound biomicroscopy, Scheimpflug photography, anterior segment optical coherence tomography and EyeCam, highlighting the current clinical evidence comparing these devices with each other and with clinical dynamic indentation gonioscopy, the current reference standard.

The role of standard automated perimetry and newer functional methods for glaucoma diagnosis and follow-up.

Automated perimetry has become the mainstream for assessment of functional glaucomatous loss and progressive damage. Recent improvements with the Swedish interactive thresholding algorithm (SITA) strategy and the guided progression analysis (GPA) have further settled standard achromatic perimetry (SAP) as the preferred method for diagnosis and follow-up of functional loss. Although SAP is still considered the gold standard, function-specific perimetry may offer advantages for early diagnosis. Frequency doubling technology (FDT) and short-wavelength automated perimetry (SWAP) have been shown to be helpful, especially when SAP is normal and there is a suspicion of glaucoma. Studies using rarebit perimetry have also shown promising results. Studies have observed that each test identifies a different subset of eyes, and combining the tests may improve sensitivity. Nevertheless, the more sophisticated analyses do not reduce the importance of a correct interpretation of the test results.

Desenvolvimento de um instrumento automatizado para medida do campo visual do olho humano / Development of an automated instrumento for human visual field measurements

Neste artigo é descrito o desenvolvimento de um instrumento computadorizado para medidas do campo visual do olho humano. Apresentam-se detalhes da implementação do primeiro protótipo (hardware e software) e resultados preliminares em testes in vivo. Sabe-se que algumas patologias de grande risco para qualidade da visão, como o glaucoma (aumento da pressão intra-ocular), provocam lentamente a morte de células sensoriais (cones e bastonetes)na retina. Normalmente, o paciente só percebe o problema quando aproximadamente 50 por cento destas células já estiverem mortas. Um dos instrumentos que pode auxiliar no diagnóstico precoce destas patologias é campímetro automatizado. Apesar de existirem instrumentos importados que realizam este exame, eles contêm softwares que utilizam bases de dados geradas a partir de exames em população com características demográficas bastante diferentes daquelas encontradas no Brasil. Normalmente, essas bases de dados são provenientes dos EUA e Europa, mas sabe-se que a predisposição a diversas patologias está associada às condições demográficas (por exemplo, descobriu-se que na população de pele negra a incidência de glaucoma é maior quando comparada com a população de cor branca, em termos gerais e para residentes em uma mesma região geográfica). Além da raça, fatores como temperatura, clima e radiação solar podem também influenciar a sensibilidade visual. Assim, o desenvolvimento de um instrumento que incorpore uma base de dados colhida em olhos da população brasileira, possibilitará exames mais precisos no país. Apresenta-se aqui as diferentes etapas do desenvolvimento deste instrumento e os resultados preliminares.

Guía de examen ocular para médicos generales

Se presenta en forma resumida una metodología práctica del examen ocular que le sea útil al médico general que labora en instituciones no especializadas y en forma particular