Optic Nerve Head Changes After Intraocular Pressure-Lowering Glaucoma Surgeries Using Optical Coherence Tomography.

PRCIS: Optic nerve head (ONH) changes were detected with swept-source optical coherence tomography (SS-OCT) after intraocular pressure (IOP)-lowering glaucoma surgeries. PURPOSE: The aim of this study was to detect changes in the ONH with SS-OCT after IOP-lowering procedures. PATIENTS AND METHODS: Patients with progressing glaucoma who were referred for IOP-lowering procedures were included. The participants underwent a 24-2 visual field test and SS-OCT (DRI OCT Triton Plus; Topcon). IOP and SS-OCT scans were obtained during the preoperative period and up to 7 days and 30-90 days postoperatively. ONH parameters were measured with a B -scan at the center of the optic disc and an average of 5 central B -scans. The hypotenuse of the ONH cup (HOC) was calculated using the Pythagorean theorem: hypotenuse 2 = leg1 2 + leg2 2 , considering the length and depth of the cup as the legs of a right triangle. We also evaluated changes in Bruch membrane opening (BMO)-to-BMO diameter. Statistical analysis was performed using generalized estimating equations. RESULTS: A total of 15 eyes were included. The mean patient age was 70 (SD, 11.04) years. The mean circumpapillary retinal nerve fiber layer was 60.13 (SD, 23.21) µm and the visual field mean deviation was -13.29 (SD, 8.5) dB. The mean IOP at each visit was: 20.5 (SD, 4.99); 11 (SD, 4.95), and 15.7 (SD, 5.04), respectively. The mean HOC, the mean depth and length of the ONH cup, and the BMO-to-BMO diameter decreased significantly after the IOP-lowering procedures. CONCLUSIONS: The HOC evaluated with SS-OCT significantly decreased after IOP-lowering surgeries. This parameter was useful for evaluating short-term changes in the ONH.

Glaucoma suspects referred by general ophthalmologists to a tertiary center in Brazil: outcomes of the glaucoma specialist assessment / Suspeitos de glaucoma encaminhados do oftalmologista geral para um centro terciário no Brasil: resultados da avaliação do especialista em glaucoma

ABSTRACT Purpose: To characterize patients with suspected glaucoma who were referred to the clinic for suspected glaucoma in a tertiary public hospital in southern Brazil and to evaluate differences in functional and structural damages between patients diagnosed with different types of glaucoma, those with normal eye examination results, and those who remained as glaucoma suspects. Methods: This is a cohort study of patients referred by general ophthalmologists to the clinic for suspected glaucoma at Hospital Nossa Senhora da Conceição, Porto Alegre, Brazil, between March 2016 and December 2018. The patients were followed up until they had undergone reliable examinations (eye examination, visual field screening, and optic coherence tomography for classification as normal and having a suspected glaucoma, glaucoma with an elevated intraocular pressure, normotensive glaucoma, or ocular hypertension. Results: A total of 135 patients were included in this study. Of the patients, 117 subjects completed all examinations and met the inclusion criteria. Most patients were normal (36.8%), followed by those with suspected glaucoma (25.64%), normal tension glaucoma (18.8%), glaucoma with elevated intraocular pressure (12%), and ocular hypertensive (6%). The main reason for referral was increased optic nerve head cupping. The patients with normal tension glaucoma were older than the other subjects on average (p=0.03). In addition, the normal tension glaucoma group had a significantly worse baseline visual field index and mean deviation of the visual field than the normal, glaucoma suspect, and ocular hypertensive groups. The circumpapillary retinal nerve fiber layer on OCT was thinner on average in the normal tension glaucoma group than in the normal and glaucoma suspect groups (p<0.002) but did not significantly differ between the glaucoma group with elevated intraocular pressure and the other groups. Conclusions: Patients with normal tension glaucoma tend to be diagnosed later because of their normal intraocular pressures; thus, the optic nerve cupping must be greater to raise the suspicion of glaucoma. In this study, we found that the patients with normal tension glaucoma had worse disease at the time of diagnosis.

RESUMO Objetivo: Caracterizar a população com suspeita de glaucoma encaminhada a um centro público terciário no sul do Brasil e avaliar diferenças no dano dos parâmetros funcionais e estruturais entre os pacientes diagnosticados com diferentes tipos de glaucoma e aqueles classificados como normais e aqueles mantidos como suspeitos de glaucoma. Métodos: Esta é uma coorte dos pacientes encaminhados para o setor de glaucoma suspeito do Hospital Nossa Senhora da Conceição, Porto Alegre - BR, no período de março de 2016 a dezembro de 2018. Os pacientes foram acompanhados até obterem exames confiáveis (exame oftalmológico completo, campimetria visual, tomografia de coerência óptica) para serem classificados como: normal, glaucoma suspeito, glaucoma com pressão intraocular elevada, glaucoma de pressão normal ou hipertenso ocular. Resultados: Um total de 135 pacientes foram incluídos neste estudo, sendo que destes, 117 pacientes completaram todos os exames e foram incluídos neste estudo. A maioria dos pacientes foi considerada normal (36,8%), seguido por glaucoma suspeito (25,64%), glaucoma de pressão normal (18,8%), glaucoma com pressão intraocular elevada (12%) e hipertensão ocular (6%). A principal razão para encaminhamento foi escavação do nervo óptico aumentada. Pacientes com glaucoma de pressão normal eram em média mais velhos que os demais (p=0,03). Esses também apresentavam índice de campo visual e desvio médio da campimetria visual piores que sujeitos normal, com suspeita de glaucoma e hipertensos oculares, e tinham a camada de fibra nervosa medida pela tomografia de coerência óptica mais fina que normais e suspeitos de glaucoma (p<0,002). Os pacientes com glaucoma de pressão elevada não diferiram significativamente dos outros grupos. Conclusão: Pacientes com glaucoma de pressão normal tendem a ser diagnosticados mais tardiamente devido ao fato da pressão intraocular não estar elevada, logo a escavação do disco óptico deve ser maior para gerar a suspeita de glaucoma. Neste estudo, paciente com glaucoma de pressão normal apresentaram doença mais avançada no momento do diagnóstico em comparação com os outros grupos.

Glaucoma suspects referred by general ophthalmologists to a tertiary center in Brazil: outcomes of the glaucoma specialist assessment.

PURPOSE: To characterize patients with suspected glaucoma who were referred to the clinic for suspected glaucoma in a tertiary public hospital in southern Brazil and to evaluate differences in functional and structural damages between patients diagnosed with different types of glaucoma, those with normal eye examination results, and those who remained as glaucoma suspects. METHODS: This is a cohort study of patients referred by general ophthalmologists to the clinic for suspected glaucoma at Hospital Nossa Senhora da Conceição, Porto Alegre, Brazil, between March 2016 and December 2018. The patients were followed up until they had undergone reliable examinations (eye examination, visual field screening, and optic coherence tomography for classification as normal and having a suspected glaucoma, glaucoma with an elevated intraocular pressure, normotensive glaucoma, or ocular hypertension. RESULTS: A total of 135 patients were included in this study. Of the patients, 117 subjects completed all examinations and met the inclusion criteria. Most patients were normal (36.8%), followed by those with suspected glaucoma (25.64%), normal tension glaucoma (18.8%), glaucoma with elevated intraocular pressure (12%), and ocular hypertensive (6%). The main reason for referral was increased optic nerve head cupping. The patients with normal tension glaucoma were older than the other subjects on average (p=0.03). In addition, the normal tension glaucoma group had a significantly worse baseline visual field index and mean deviation of the visual field than the normal, glaucoma suspect, and ocular hypertensive groups. The circumpapillary retinal nerve fiber layer on OCT was thinner on average in the normal tension glaucoma group than in the normal and glaucoma suspect groups (p<0.002) but did not significantly differ between the glaucoma group with elevated intraocular pressure and the other groups. CONCLUSIONS: Patients with normal tension glaucoma tend to be diagnosed later because of their normal intraocular pressures; thus, the optic nerve cupping must be greater to raise the suspicion of glaucoma. In this study, we found that the patients with normal tension glaucoma had worse disease at the time of diagnosis.

Swept Source Optical Coherence Tomography Documenting Optic Nerve Involvement in an Aggressive T-Cell Lymphoma.

Peripheral T-cell lymphomas (PTCLs) are a heterogeneous group of aggressive neoplasms. The involvement of ocular structures in haematological neoplasms is rare and usually associated with central nervous system involvement, which may occur as a result of orbital invasion and optic nerve infiltration. In this case report, we describe ocular findings using the novel swept source optical coherence tomography (SS-OCT) in a case of aggressive T-cell lymphoma. SS-OCT has faster scanning speed, deeper tissue penetration due to its longer wavelength laser of 1050 nm and wider scanning areas. In the present case, SS-OCT was helpful in documenting increased retinal nerve fibre layer thickness and prelaminar protrusion associated with visual loss in a patient with an aggressive T-cell lymphoma.

Individual Macular Layer Evaluation with Spectral Domain Optical Coherence Tomography in Normal and Glaucomatous Eyes.

PURPOSE: To evaluate differences in the thickness of the individual macular layers between early, moderate, and severe glaucomatous eyes and compare them with healthy controls. PATIENTS AND METHODS: Subjects with glaucoma presenting typical optic nerve head findings, high intraocular pressure with or without visual field (VF) damage and normal controls were included. All participants underwent 24-2 perimetry and spectral-domain OCT. Patients were divided into three groups (early, moderate, and severe) based on the mean deviation of the VF and a healthy control group. The device segmented the layers automatically, and their measurements were plotted using the means of the sectors of the inner (3mm) and outer (6mm) circles of the ETDRS grid. RESULTS: A total of 109 eyes qualified for the study: 14 in the control group and 52, 18 and 25 in the early, moderate and severe groups, respectively. Mean age was 66.13 (SD=12.38). The mean thickness of the circumpapillary retinal nerve fiber layer (RNFL), total macular thickness (TMT), macular RNFL, ganglion cell layer (GCL) and inner plexiform layer (IPL) were significantly different between the 4 groups, with progressive decrease in thickness. Significant overall difference was found for the inner nuclear layer (INL), and the severe glaucoma group presented thicker measurements than controls and early glaucoma. Outer nuclear layer (ONL) was thinner in severe glaucoma group compared with early glaucoma group. CONCLUSION: Individual macular layer measurement using the inner and outer circles of the ETDRS grid is useful to evaluate different stages of glaucoma. The INL thickening and ONL thinning in advanced glaucoma should be explored in the future studies.

Intraocular pressure in very low birth weight preterm infants and its association with postconceptional age.

OBJECTIVE: To evaluate intraocular pressure in very low birth weight preterm infants and correlate it with postconceptional age. METHODS: The intraocular pressure in a prospective cohort of very low birth weight premature infants (defined as a birth weight ≤1,500 g and gestational age ≤32 weeks) admitted to Hospital de Clínicas de Porto Alegre , Brazil was evaluated weekly. The evaluated outcome was the variation in the intraocular pressure following changes in the postconceptional age (defined as the gestational age at birth plus the age in weeks at the time of examination) in the weeks following preterm birth. Mixed-effects models were used for the statistical analysis to determine the intraocular pressure variation according to postconceptional age, and means and 10th and 90th percentiles were calculated for the intraocular pressure values. RESULTS: Fifty preterm infants with a mean gestational age of 29.7 ± 1.6 weeks and a mean birth weight of 1,127.7 ± 222.7 g were evaluated. The mean intraocular pressure for the entire cohort considering both eyes was 14.9 ± 4.5 mmHg, and 13.5% of all recorded intraocular pressure values were greater than 20 mmHg. The analysis revealed a mean reduction in the intraocular pressure of 0.29 mmHg for each increase in postconceptional age (p = 0.047; 95% CI: -0.58 to -0.0035). The mean intraocular pressure (P10-P90) decreased from 16.3 mmHg (10.5222.16) at 26.3 weeks to 13.1 mmHg (7.28-18.92) at 37.6 weeks of postconceptional age. CONCLUSIONS: The mean intraocular pressure in very low birth weight preterm infants was 14.9 ± 4.5 mmHg. This value decreased 0.29 mmHg per week as the postconceptional age increased.

Intraocular pressure in very low birth weight preterm infants and its association with postconceptional age

OBJECTIVE: To evaluate intraocular pressure in very low birth weight preterm infants and correlate it with postconceptional age. METHODS: The intraocular pressure in a prospective cohort of very low birth weight premature infants (defined as a birth weight <1,500 g and gestational age <32 weeks) admitted to Hospital de Clínicas de Porto Alegre , Brazil was evaluated weekly. The evaluated outcome was the variation in the intraocular pressure following changes in the postconceptional age (defined as the gestational age at birth plus the age in weeks at the time of examination) in the weeks following preterm birth. Mixed-effects models were used for the statistical analysis to determine the intraocular pressure variation according to postconceptional age, and means and 10th and 90th percentiles were calculated for the intraocular pressure values. RESULTS: Fifty preterm infants with a mean gestational age of 29.7 ± 1.6 weeks and a mean birth weight of 1,127.7 ± 222.7 g were evaluated. The mean intraocular pressure for the entire cohort considering both eyes was 14.9 ± 4.5 mmHg, and 13.5% of all recorded intraocular pressure values were greater than 20 mmHg. The analysis revealed a mean reduction in the intraocular pressure of 0.29 mmHg for each increase in postconceptional age (p = 0.047; 95% CI: -0.58 to -0.0035). The mean intraocular pressure (P10-P90) decreased from 16.3 mmHg (10.5222.16) at 26.3 weeks to 13.1 mmHg (7.28-18.92) at 37.6 weeks of postconceptional age. CONCLUSIONS: The mean intraocular pressure in very low birth weight preterm infants was 14.9 ± 4.5 mmHg. This value decreased 0.29 mmHg per week as the postconceptional age increased.

HLA-matched living-related conjunctival limbal allograft for bilateral ocular surface disorders: long-term results / Transplante alogênico inter vivo de limbo conjuntival com pareamento HLA em doenças bilaterais da superfície ocular: resultados em longo prazo

PURPOSE: To evaluate the long-term outcome of HLA-matched lr-CLAL for bilateral ocular surface disorders. METHODS: A retrospective, non-comparative interventional case series study of 39 eyes of 32 patients with bilateral surface disorders and clinical diagnosis of limbal stem cell deficiency who underwent HLA-matched lr-CLAL. Visual acuity (VA), ambulatory vision (> 20/200) and ocular surface stability were evaluated as main outcomes. Donor limbus was obtained from a sibling or a parent of the patient, after an appropriate Class I and II HLA match. RESULTS: One year after surgery, VA improved in 46.2 percent, ambulatory vision was achieved in 48.7 percent and a stable corneal surface was achieved in 84.6 percent of the eyes. At the final follow-up (mean, 48.7 ± 30.6 months), 66.6 percent of the eyes that had gained VA one year after surgery maintained an improved VA (p=0.28), 94.7 percent of eyes that had achieved ambulatory vision one year after surgery maintained 20/200 or better (p<0.001) and 93.9 percent still had a stable corneal surface (p=0.043) at the final follow-up. CONCLUSIONS: HLA-matched lr-CLAL can be an adequate method of treatment for bilateral ocular surface disorders, with a reasonable percentage of success of long-term results.

OBJETIVO: Avaliar os resultados em longo prazo do transplante alogênico inter vivo de limbo conjuntival para doenças bilaterais da superfície ocular com compatibilidade HLA doador-receptor. MÉTODOS: Estudo retrospectivo, não comparativo e intervencionista de 39 olhos de 32 pacientes submetidos a transplante alogênico de limbo com compatibilidade HLA e diagnóstico de deficiência límbica. Foram analisados como desfechos principais acuidade visual, visão ambulatorial (> 20/200) e estabilidade da superfície ocular. Limbo doador foi obtido de parentes do paciente após estudo de compatibilidade HLA classe I e II. RESULTADOS: Com um ano de pós-operatório, a acuidade visual melhorou em 46,2 por cento, visão ambulatorial foi atingida em 48,7 por cento e estabilidade da superfície corneana em 84,6 por cento dos pacientes. Ao final do seguimento (média, 48,7 ± 30,6 meses), 66,6 por cento dos olhos que haviam ganho acuidade visual um ano após a cirurgia mantiveram esta melhora (p=0,28), 94,7 por cento dos olhos que haviam alcançado visão ambulatorial um ano após a cirurgia mantiveram visão de 20/200 ou melhor (p<0,001) e 93,9 por cento ainda tinham superfície corneana estável (p=0,043) ao final do seguimento. CONCLUSÕES: O transplante alogênico inter vivo de limbo conjuntival com compatibilidade HLA revelou-se método adequado no tratamento de doenças bilaterais da superfície ocular, com uma porcentagem significativa de sucesso a longo-prazo.

HLA-matched living-related conjunctival limbal allograft for bilateral ocular surface disorders: long-term results.

PURPOSE: To evaluate the long-term outcome of HLA-matched lr-CLAL for bilateral ocular surface disorders. METHODS: A retrospective, non-comparative interventional case series study of 39 eyes of 32 patients with bilateral surface disorders and clinical diagnosis of limbal stem cell deficiency who underwent HLA-matched lr-CLAL. Visual acuity (VA), ambulatory vision (> or = 20/200) and ocular surface stability were evaluated as main outcomes. Donor limbus was obtained from a sibling or a parent of the patient, after an appropriate Class I and II HLA match. RESULTS: One year after surgery, VA improved in 46.2%, ambulatory vision was achieved in 48.7% and a stable corneal surface was achieved in 84.6% of the eyes. At the final follow-up (mean, 48.7 +/- 30.6 months), 66.6% of the eyes that had gained VA one year after surgery maintained an improved VA (p=0.28), 94.7% of eyes that had achieved ambulatory vision one year after surgery maintained 20/200 or better (p<0.001) and 93.9% still had a stable corneal surface (p=0.043) at the final follow-up. CONCLUSIONS: HLA-matched lr-CLAL can be an adequate method of treatment for bilateral ocular surface disorders, with a reasonable percentage of success of long-term results.