Silicone Ahmed glaucoma valve with and without intravitreal triamcinolone acetonide for neovascular glaucoma: randomized clinical trial.

PURPOSE: To compare the effect on intraocular pressure (IOP) of the silicone Ahmed glaucoma valve with and without an intravitreal injection of triamcinolone acetonide. PATIENTS AND METHODS: Forty-nine patients with clinically uncontrolled neovascular glaucoma were included in the study; 22 were randomly assigned to the study group (silicone Ahmed glaucoma valve implant with intravitreal triamcinolone acetonide) and 27 to the control group (silicone Ahmed glaucoma valve). IOP was the primary outcome measure in this study. The secondary outcome measure was success, defined by IOP lower than 22 mm Hg and higher than 5 mm Hg, and no serious complications. Success rates in both the groups were compared using Kaplan-Meier survival curves and the log-rank test. IOP levels were compared using mixed linear model analysis to correct for repeated measures correlation. RESULTS: Forty-three patients, 18 in the study group and 25 in the control group, completed the study (follow-up of 12 mo). The mean IOP was significantly lower after 1 year in both the groups (P<0.001). The mean IOP in the first month of follow-up was lower in the study group (control; 20.4±9.7, study; 13.6±6.5, P<0.01). The success rate at 1 year was 78% for the study group and 76% for the control group (P=0.82). Complication rates were not different between the groups. CONCLUSIONS: Intravitreal injection of triamcinolone acetonide in neovascular glaucoma did not affect the intermediate-term success of the silicone Ahmed valve nor reduce the incidence of complications. The mean IOP spike in the first month was lower in the triamcinolone group.

Intraocular pressure, corneal thickness, and corneal hysteresis in Steinert's myotonic dystrophy.

PURPOSE: Low intraocular pressure (IOP) measured by Goldmann applanation tonometry (GAT) is one of the ocular manifestations of Steinert's myotonic dystrophy. The goal of this study was to evaluate the corneal-compensated IOP as well as corneal properties (central corneal thickness and corneal hysteresis) in patients with myotonic dystrophy. METHODS: A total of 12 eyes of 6 patients with Steinert's myotonic dystrophy (dystrophy group) and 12 eyes of 6 age-, race-, and gender-matched healthy volunteers (control group) were included in the study. GAT, Dynamic Contour Tonometry (DCT-Pascal) and Ocular Response Analyzer (ORA) were used to assess the IOP. Central corneal thickness was obtained by ultrasound pachymetry, and corneal hysteresis was analyzed using the ORA device. In light of the multiplicity of tests performed, the significance level was set at 0.01 rather than 0.05. RESULTS: The mean (standard deviation [SD]) GAT, DCT, and corneal-compensated ORA IOP in the dystrophy group were 5.4 (1.4) mmHg, 9.7 (1.5) mmHg, and 10.1 (2.6) mmHg, respectively. The mean (SD) GAT, DCT, and corneal-compensated ORA IOP in the control group was 12.6 (2.9) mmHg, 15.5 (2.7) mmHg, and 15.8 (3.4) mmHg, respectively. There were significant differences in IOP values between dystrophy and control groups obtained by GAT (mean, -7.2 mmHg; 99% confidence interval [CI], -10.5 to -3.9 mmHg; P<0.001), DCT (mean, -5.9 mmHg; 99% CI, -8.9 to -2.8 mmHg; P<0.001), and corneal-compensated ORA measurements (mean, -5.7 mmHg; 99% CI, -10.4 to -1.0 mmHg; P=0.003). The mean (SD) central corneal thickness was similar in the dystrophy (542 [31] µm) and control (537 [11] µm) groups (P=0.65). The mean (SD) corneal hysteresis in the dystrophy and control groups were 11.2 (1.5) mmHg and 9.7 (1.2) mmHg, respectively (P=0.04). CONCLUSIONS: Patients with Steinert's myotonic dystrophy showed lower Goldmann and corneal-compensated IOP in comparison with healthy individuals. Since central corneal thickness and corneal hysteresis did not differ significantly between groups, the lower IOP readings documented in this dystrophy seem not to be related to changes in corneal properties.

Intraocular pressure, corneal thickness, and corneal hysteresis in Steinert's myotonic dystrophy / Pressão intraocular, espessura corneal e histerese corneal em distrofia miotônica de Steinert

PURPOSE: Low intraocular pressure (IOP) measured by Goldmann applanation tonometry (GAT) is one of the ocular manifestations of Steinert's myotonic dystrophy. The goal of this study was to evaluate the corneal-compensated IOP as well as corneal properties (central corneal thickness and corneal hysteresis) in patients with myotonic dystrophy. METHODS: A total of 12 eyes of 6 patients with Steinert's myotonic dystrophy (dystrophy group) and 12 eyes of 6 age-, race-, and gender-matched healthy volunteers (control group) were included in the study. GAT, Dynamic Contour Tonometry (DCT-Pascal) and Ocular Response Analyzer (ORA) were used to assess the IOP. Central corneal thickness was obtained by ultrasound pachymetry, and corneal hysteresis was analyzed using the ORA device. In light of the multiplicity of tests performed, the significance level was set at 0.01 rather than 0.05. RESULTS: The mean (standard deviation [SD]) GAT, DCT, and corneal-compensated ORA IOP in the dystrophy group were 5.4 (1.4) mmHg, 9.7 (1.5) mmHg, and 10.1 (2.6) mmHg, respectively. The mean (SD) GAT, DCT, and corneal-compensated ORA IOP in the control group was 12.6 (2.9) mmHg, 15.5 (2.7) mmHg, and 15.8 (3.4) mmHg, respectively. There were significant differences in IOP values between dystrophy and control groups obtained by GAT (mean, -7.2 mmHg; 99 percent confidence interval [CI], -10.5 to -3.9 mmHg; P<0.001), DCT (mean, -5.9 mmHg; 99 percent CI, -8.9 to -2.8 mmHg; P<0.001), and corneal-compensated ORA measurements (mean, -5.7 mmHg; 99 percent CI, -10.4 to -1.0 mmHg; P=0.003). The mean (SD) central corneal thickness was similar in the dystrophy (542 [31] µm) and control (537 [11] µm) groups (P=0.65). The mean (SD) corneal hysteresis in the dystrophy and control groups were 11.2 (1.5) mmHg and 9.7 (1.2) mmHg, respectively (P=0.04). CONCLUSIONS: Patients with Steinert's myotonic dystrophy showed lower Goldmann and corneal-compensated IOP in comparison with healthy individuals. Since central corneal thickness and corneal hysteresis did not differ significantly between groups, the lower IOP readings documented in this dystrophy seem not to be related to changes in corneal properties.

OBJETIVOS: Pressão intraocular (PIO) baixa medida por meio da tonometria de aplanação de Goldmann (TAG) é uma das manifestações oculares da distrofia miotônica de Steinert. O objetivo deste estudo foi avaliar a pressão intraocular compensada para as propriedades corneais (espessura corneal central e histerese corneal) em pacientes com distrofia miotônica. MÉTODOS: Um total de 12 olhos de 6 pacientes com distrofia miotônica de Steinert (grupo distrofia) e 12 olhos de 6 voluntários sadios (grupo controle) pareados para idade, raça e sexo foram incluídos no estudo. Tonometria de aplanação de Goldmann, tonometria de contorno dinâmico (TCD-Pascal) e analisador de resposta ocular (ORA) foram usados para medir a pressão intraocular. A espessura corneal central foi obtida por meio da paquimetria ultrassônica e a histerese corneal foi analizada usando o aparelho ORA. RESULTADOS: A pressão intraocular média (desvio-padrão) da TAG, TCD e compensada para a córnea do ORA no grupo distrofia foram 5,4 (1,4) mmHg, 9,7 (1,5) mmHg e 10,1 (2,6) mmHg, respectivamente. A pressão intraocular média (desvio-padrão) da TAG, TCD e compensada para a córnea do ORA no grupo controle foram 12,6 (2,9) mmHg, 15,5 (2,7) mmHg e 15,8 (3,4) mmHg, respectivamente. Houve diferença significativa nos valores da pressão intraocular entre os grupos distrofia e controle obtidas pela TAG (média, -7,2 mmHg; intervalo de confiança (IC) de 99 por cento, -10,5 a -3,9 mmHg; P<0,001), TCD (média, -5,9 mmHg; IC de 99 por cento, -8,9 a -2,8 mmHg; P<0,001) e ORA compensada para córnea (média, -5,7 mmHg; IC de 99 por cento, -10,4 a -1,0 mmHg; P=0,003). A espessura corneal média (desvio-padrão) foi similar nos grupos distrofia (542 [31] µm) e controle (537 [11] µm) (P=0,65). A histerese corneal média (desvio-padrão) nos grupos distrofia e controle foram de 11,2 (1,5) mmHg e 9,7 (1,2) mmHg, respectivamente (P=0,04). CONCLUSÃO: Os pacientes com distrofia miotônica de Steinert apresentaram valores menores de pressão intraocular medidas tanto com Goldmann quanto compensadas para a córnea em comparação com indivíduos sadios. Uma vez que os valores da espessura corneal central e histerese corneal não diferiram significantemente entre os grupos, os valores baixos da pressão intraocular encontrados nos pacientes com distrofia miotônica não parecem estar relacionados com as propriedades corneais.

Correlation between diurnal variation of intraocular pressure, ocular pulse amplitude and corneal structural properties.

PURPOSE: The purpose of this study was to evaluate the fluctuation of intraocular pressure measurements obtained by Goldmann applanation tonometry, dynamic contour tonometry, and corneal compensated non-contact tonometry during office hours in glaucoma and healthy participants. This study also aims at correlating the intraocular pressure fluctuations with fluctuations of corneal hysteresis, central corneal thickness, mean central corneal curvature and ocular pulse amplitude. METHODS: A total of 12 controls (24 eyes) and 21 patients (38 eyes) with open-angle glaucoma were recruited. Intraocular pressure measured by Goldmann applanation tonometry, dynamic contour tonometry and corneal compensated non-contact tonometry, ocular pulse amplitude, central corneal curvature and thickness, corneal hysteresis, and resistance factor were obtained at intervals of 2 hours, between 9 AM and 5 PM. RESULTS: Intraocular pressure fluctuated significantly throughout the day in controls and glaucoma individuals with all tonometers (P<0.001). There was no statistically significant variation in mean corneal curvature (P=0.048 in controls; P=0.04 in glaucomatous) or hysteresis over time (P=0.12 in controls; P=0.36 in glaucomatous). The ocular pulse amplitude showed a significant diurnal fluctuation in both groups (P<0.001). There was a significant correlation between the intraocular pressure measured by dynamic contour tonometry and ocular pulse amplitude (P<0.001). CONCLUSION: There was significant intraocular pressure fluctuation over office hours on measurements performed by Goldmann applanation tonometry, dynamic contour tonometry, and corneal compensated non-contact tonometry in normal and glaucoma individuals. Intraocular pressure varied independently of corneal hysteresis, central corneal thickness, and central curvature variation. However, there was significant correlation between ocular pulse amplitude and intraocular pressure measurements performed by dynamic contour tonometry.

Correlation between diurnal variation of intraocular pressure, ocular pulse amplitude and corneal structural properties / Correlação entre a variação diurna da pressão intraocular, amplitude de pulso e propriedades estruturais corneanas

PURPOSE: The purpose of this study was to evaluate the fluctuation of intraocular pressure measurements obtained by Goldmann applanation tonometry, dynamic contour tonometry, and corneal compensated non-contact tonometry during office hours in glaucoma and healthy participants. This study also aims at correlating the intraocular pressure fluctuations with fluctuations of corneal hysteresis, central corneal thickness, mean central corneal curvature and ocular pulse amplitude. METHODS: A total of 12 controls (24 eyes) and 21 patients (38 eyes) with open-angle glaucoma were recruited. Intraocular pressure measured by Goldmann applanation tonometry, dynamic contour tonometry and corneal compensated non-contact tonometry, ocular pulse amplitude, central corneal curvature and thickness, corneal hysteresis, and resistance factor were obtained at intervals of 2 hours, between 9 AM and 5 PM. RESULTS: Intraocular pressure fluctuated significantly throughout the day in controls and glaucoma individuals with all tonometers (P<0.001). There was no statistically significant variation in mean corneal curvature (P=0.048 in controls; P=0.04 in glaucomatous) or hysteresis over time (P=0.12 in controls; P=0.36 in glaucomatous). The ocular pulse amplitude showed a significant diurnal fluctuation in both groups (P<0.001). There was a significant correlation between the intraocular pressure measured by dynamic contour tonometry and ocular pulse amplitude (P<0.001). CONCLUSION: There was significant intraocular pressure fluctuation over office hours on measurements performed by Goldmann applanation tonometry, dynamic contour tonometry, and corneal compensated non-contact tonometry in normal and glaucoma individuals. Intraocular pressure varied independently of corneal hysteresis, central corneal thickness, and central curvature variation. However, there was significant correlation between ocular pulse amplitude and intraocular pressure measurements performed ...

OBJETIVO: Avaliar a flutuação das medidas da pressão intraocular obtidas pela tonometria de aplanação de Goldmann, tonometria de contorno dinâmico e pela tonometria de não-contato com compensação corneana durante o período ambulatorial, em participantes com glaucoma e saudáveis. Esse estudo também correlacionou as flutuações da pressão intraocular com as flutuações da histerese corneana, espessura corneana central, média da curvatura corneana central e amplitude de pulso ocular. MÉTODOS: Um total de 12 controles (24 olhos) e 21 pacientes com glaucoma de ângulo aberto (38 olhos) foram selecionados. A pressão intraocular medida pela tonometria de aplanação de Goldmann, tonometria de contorno dinâmico e tonometria de não-contato com compensação corneana, amplitude de pulso ocular, a curvatura central e espessura corneanas, a histerese corneana e o fator de resistência foram medidos em intervalos de 2 horas, entre 9 AM e 5 PM. RESULTADOS: A pressão intraocular flutuou significativamente durante o dia em indivíduos controles e com glaucoma em todos os tonômetros (P<0,001). Não houve variação estatisticamente significante na média da curvatura corneana central (P=0,048 em controles; P=0,04 em glaucomatosos) ou na histerese no período pesquisado (P=0,12 em controles; P=0,36 em glaucomatosos). A amplitude de pulso ocular mostrou uma flutuação diurna significativa em ambos os grupos (P<0,001). Houve uma correlação significante entre a pressão intraocular medida pela tonometria de contorno dinâmico e a amplitude de pulso ocular (P<0,001). CONCLUSÃO: Houve uma flutuação significante da pressão intraocular ao longo do período ambulatorial nas medidas realizadas pela tonometria de aplanação de Goldmann, tonometria de contorno dinâmico, e tonometria de não-contato com compensação corneana em indivíduos normais e com glaucoma. A pressão intraocular variou independente da variação da histerese, espessura e curvatura central corneanas. Entretanto, houve ...

Prevalência e custos indiretos das cefaléias em uma empresa brasileira / Prevalence and indirect costs of headache in a Brazilian Company

Funcionários de uma empresa (n=993) foram entrevistados quanto à ocorrência de cefaléias durante um período retrospectivo de 30 dias. A prevalência foi 49,8 por cento, com frequência de 4,3+7,0 episódios e duraçao de 12,2+21,4 horas. Os diagnósticos baseados na classificaçao da Sociedade Internacional de Cefaléias, foram enxaqueca (5,5 por cento), cefaléia do tipo tensao (CTT) episódica (26,4 por cento), CTT crônica (1,7 por cento) e outras cefaléias (16,2 por cento). As mulheres foram mais acometidas e tiveram proporcionalmente mais enxaquecas que os homens. Cerca de 10 por cento dos pacientes relataram dor suficientemente intensa a ponto de prejudicar seu desempenho no trabalho, o que representou 538,75 horas nao trabalhadas. O custo indireto proporcionado pela interferência no trabalho foi estimado para cada cefaléia. O potencial prejuízo projetado à empresa devido às cefaléias é R$ 145,64 por funcionário, ou R$ 144 682,39 por ano. Como a enxaqueca é a cefaléia de maior custo, seu controle é particularmente importante no ambiente de trabalho. Há meios eficazes para reduzir sua frequência, com reflexos positivos no bem-estar e na produtividade do indivíduo. A relaçao custo-benefício favorece claramente a instituiçao de programas de prevençao e tratamento contra cefaléias crônicas.