RESUMO
ABSTRACT Purpose: To report the distribution of referral reasons for children from a pediatric glaucoma outpatient clinic in a tertiary eye care service. Methods: The medical records of patients aged <18 years who were referred to a pediatric glaucoma center in the city of São Paulo, Brazil, between 2012 and 2018 were retrospectively reviewed. The data collected included the referral reasons, age, hospital of origin, and who detected the ocular alteration. For defining the diagnosis, the Childhood Glaucoma Research Network classification was used. Results: Five hundred sixty-three eyes of 328 patients were included in the study. Glaucoma diagnosis was confirmed in 162 children (49%). In 83 patients (25%), the glaucoma diagnosis was ruled out, and 83 (25%) continued outpatient follow-up for suspected glaucoma. The main referral reasons were a cup-to-disc ratio >0.5 or an asymmetry ≥0.2 (24%), intraocular pressure >21 mmHg (21%), and corneal opacity (15%). In the neonatal period, the referral reasons were corneal opacity, buphthalmos, tearing, and photophobia. After the neonatal period, besides these external changes, other signs were also reasons for referral, such as cup-to-disc ratio >0.5 or asymmetry ≥0.2, intraocular pressure >21 mmHg, and myopic shift. The referrals were made by health professionals in 69% and parental concern in 30% of the cases. In 97% of the primary congenital glaucoma cases, the parents were the first to identify the change and to seek for health care. Conclusions: The referral reasons of the children to a tertiary glaucoma clinic were differed between the age groups and diagnoses. We suggest that awareness with these findings is important to avoid and postpone diagnosis, identify their impacts on prognosis, and avoid spending important resources for the management of diseases with inaccurate referrals.
RESUMO Objetivos: Relatar a distribuição dos motivos de encaminhamento de crianças para ambulatório de glaucoma infantil em um serviço oftalmológico terciário. Métodos: Dados médicos de pacientes menores que 18 anos encaminhados para ambulatório de glaucoma infantil na cidade de São Paulo, Brasil, de 2012 a 2018 foram retrospectivamente analisados. Os dados incluíram os motivos de encaminhamento, a idade, a origem e quem detectou a alteração ocular. Para definição diagnóstica, a classificação do Childhood Glaucoma Research Network foi usada. Resultados: 563 olhos de 328 pacientes foram incluídos no estudo. O diagnóstico de glaucoma foi confirmado em 162 crianças (49%). 83 (25%) pacientes tiveram diagnóstico de glaucoma descartado, e 83 (25%) continuaram em acompanhamento como glaucoma suspeito. Os principais motivos de encaminhamento foram relação escavação-disco >0,5 ou assimetria ≥0,2 (24%), pressão intraocular >21 mmHg (21%) e opacidade corneana (15%). No período neonatal, os motivos de encaminhamento foram opacidade corneana, buftalmo, lacrimejamento e fotofobia. Após o período neonatal, além desses sinais externos, outros sinais foram também motivos de encaminhamento, como escavação-disco >0,5 ou assimetria ≥0,2, pressão intraocular >21 mmHg e miopização. Os encaminhamentos ocorreram por profissionais de saúde em 69% e preocupação dos pais em 30%. Os pais foram os primeiros a identificar as alterações e procurar cuidado médico em 97% dos casos de glaucoma congênito primário. Conclusões: Os motivos de encaminhamento de crianças para um serviço de glaucoma de glaucoma terciário foram determinados e diferem em diferentes faixas etárias e grupos. Os autores reforçam a necessidade de alertar diferentes grupos para os sinais mais comuns, a fim de evitar, não só o adiamento do diagnóstico, o que impacta no prognóstico, mas também despender recursos importantes direcionados ao enfrentamento dessas doenças, com encaminhamentos imprecisos.
RESUMO
Background Researches showed that the mitochondrial-mediated apoptosis and autophagy play an important role in the survival of retinal ganglion cells (RGCs) in glaucoma.However,whether high pressure will lead to mitochondrial-mediated apoptosis and autophagy is not elucidated.Objective This study was conducted to explore whether elevated pressure can directly induce the mitochondrial-mediated apoptosis and autophagy in cultured RGC-5 cells in vitro.Methods RGC-5 cells were exposed to self-made pressure device and treated by 0,20,40 and 60 mmHg pressure for four hours in pressurized bottles.RGC-5 cells were incubated simultaneously in sealed incubator bottles and served as normal control.The morphological changes of the cells were examined under the inverted phase-contrast microscope.The apoptosis percentages of the cells were detected by flow cytometry.Mitochondrial membrane potentials of the cells were assessed using the JC-1,a fluorescent dye.And the expressions of cytochrome C (Cyt-c),microtubule associated protein light chain 3 (LC3) and Beclin-1 protein in the cells was detected by Western blot.Results Cultured cells showed fusiform shape in the normal control group and 0 mmHg group with more dendritic process.The cell density was obviously reduced and the number of dead cells was increased in the 20,40 and 60 mmHg groups.The apoptotic percentage was (15.69 ± 0.77)％,(15.77 ± 1.14)％,(18.30± 1.07) ％,(23.28 ± 1.33)％ and (34.47± 1.17)％ in the normal control group and 0,20,40 and 60 mmHg groups,respectively,showing a significant intergroup difference (F =150.90,P＜0.001),and the apoptotic percentage in the 40 mmHg group and 60 mmHg group was significantly increased in comparison with the normal control group (both at P＜0.01).The mitochondrial membrane potential was high in the normal control group and 0 mmHg group,with the reddish fluorescence in the cells,and the reddish fluorescence was weakened in the 20 mmHg group and 40 mmHg group.The lowing of mitochondrial membrane potential was seen in the 60 mmHg group,with the green fluorescence.Compared with the normal control group,the expression of Cyt-c,LC3-Ⅱ and Beclin-1 proteins in pressured groups was correspondingly increased (all at P＜0.05).Conclusions Elevated pressure induces the morphologic change of RGC-5 cells,results in mitochondrial membrane potential reduction and mitochondrial-mediated apoptosis and autophagy.
RESUMO
Background Researches showed that microperimetry can exhibit more tiny visual function damage than conventional perimetry in glaucomatous eyes.However,the study on fixation stability of glaucoma is still rare until now.Objective This study was to compare the correlation between microperimetry Maia (Macular Integrity Assessment) and Humphrey perimetry,and to investigate the changes of the fixation stability in glaucoma patients with hemifield defect.Methods This study proposal was approved by Medical Ethic Committee of Peking University First Hospital.A cross-sectional study was performed under the informed consent of each subject.Thirtyfive eyes of 35 glaucoma patients with hemifield defect by 24-2 Humphrey perimetry were included in Peking University First Hospital from December 2013 to March 2014,and 30 eyes of 30 normal volunteers served as controls.Both Humphery (10-2) and Maia (expert 10-2) were performed on the subjects respectively and the correlation of the results between Humphery (10-2) and Maia (expert 10-2) were analyzed.Then the patients with normal hemifield on Humphrey were assigned to Maia normal group and Maia abnormal group.Fixation stability differences were compared between glaucoma group and normal control group,and between Maia normal group and Maia abnormal group.Results The moderately positive correlation was found in the mean sensitivity between Maia microperimetry and Humphrey perimetry (r=0.403,P =0.001),and the average threshold of Maia microperimetry was moderately positive correlated with the mean defect (MD) of Humphrey perimetry in glaucoma patients (r=0.438,P =0.008).The fixation stability parameter P1 was (67±17)％ and (87±10)％,and that of P2 was (70±16)％ and (88±9)％;the 63％ bicurve elipse area (BCEA) was (5.08±1.55) °2and (2.21±0.60) °2,and the 95％ BCEA was (14.74± 6.04) °2 and (2.86 ± 1.17)°2 in the glaucoma group and normal control group,respectively,showing significant decreases of P1 and P2 and increases of 63％ BCEA and 95％ BCEA in the glaucoma group compared with the normalcontrol group (t=-5.604,-4.831,9.885,11.086,all at P=0.000).In Maia normal group and Maia abnormal group,the P1 was (79±8)％ and (63±17)％,the P2 was (81±10)％ and (67±16)％,the 63％ BCEA was (3.19±0.65)°2 and (5.70±1.22)°2 and the 95％ BCEA was (9.10±2.60)°2 and (19.35±5.01)°2,respectively.Compared with the Maia normal group,the P1 and P2 were significantly lower,and 63％ BCEA and 95 ％ BCEA were higher in the Maia abnormal group (t=-2.468,P=0.019;t=-2.371,P=0.024;t =5.514,P=0.000;t=5.575,P=0.000).Conclusions Maia microperimetry and Humphrey perimetry yield a good correlation for glaucomatous macular function examination.In addition,Maia microperimetry showed that fixation stability decreased in glaucoma patients with hemifield defect.
RESUMO
Purpose To evaluate differences in the pattern of optic disc and retinal nerve fiber layer (RNFL) damage in normal tension glaucoma (NTG) and high tension glaucoma (HTG) patients. Methods We enrolled 49 eyes of 49 patients:30 NTG (IOP≤21 mm Hg,1 mm Hg=0.133 kPa), 19 HTG(IOP≥25 mm Hg). Mean age was 59.2?12.3 (range, 36-75) for HTG patients, and 59.6?8.6(range, 39-71) for NTG patients. All patients underwent complete ophthalmic examination, achromatic automated perimetry (AAP), scanning laser ophthalmoscopy (SLO), scanning laser polarimetry (SLP), optical coherence tomography (OCT) and Heidelberg retinal tomography (HRT). All patients had glaucomatous optic nerve damage and abnormal AAP. Results There were no differences in mean deviation on AAP between NTG and HTG eyes ( P =0.37), while the corrected pattern standard deviation was larger in NTG than in HTG eyes ( P =0.014). Cup∶disc area ratios in global ( P =0.03) and three sectors ( P