Correlation between macular and retinal nerve fibre layer Fourier-domain OCT measurements and visual field loss in chiasmal compression.

PURPOSE: The aim of this study was to test the correlation between Fourier-domain (FD) optical coherence tomography (OCT) macular and retinal nerve fibre layer (RNFL) thickness and visual field (VF) loss on standard automated perimetry (SAP) in chiasmal compression. METHODS: A total of 35 eyes with permanent temporal VF defects and 35 controls underwent SAP and FD-OCT (3D OCT-1000; Topcon Corp.) examinations. Macular thickness measurements were averaged for the central area and for each quadrant and half of that area, whereas RNFL thickness was determined for six sectors around the optic disc. VF loss was estimated in six sectors of the VF and in the central 16 test points in the VF. The correlation between VF loss and OCT measurements was tested with Spearman's correlation coefficients and with linear regression analysis. RESULTS: Macular and RNFL thickness parameters correlated strongly with SAP VF loss. Correlations were generally stronger between VF loss and quadrantic or hemianopic macular thickness than with sectoral RNFL thickness. For the macular parameters, we observed the strongest correlation between macular thickness in the inferonasal quadrant and VF loss in the superior temporal central quadrant (rho=0.78; P<0.001) whereas for the RNFL parameters the strongest correlation was observed between the superonasal optic disc sector and the central temporal VF defect (rho=0.60; P<0.001). CONCLUSION: Although FD-OCT RNFL and macular thickness measurements were both correlated with VF loss, the correlation was stronger with quadrantic macular than with RNFL thickness measurements in patients with temporal hemianopia. Such measurements could potentially be used to quantify neuronal loss in patients with chiasmal compression.

Intraoperative mitomycin-C without conjunctival and Tenon's capsule touch in primary trabeculectomy.

OBJECTIVE: To verify whether intraoperative mitomycin C (MMC) without conjunctival and Tenon's touch is effective in inhibiting the development of thin, avascular blebs in eyes undergoing primary trabeculectomy. DESIGN: Noncomparative, interventional study. PARTICIPANTS: Fifteen eyes of 15 consecutive patients undergoing primary trabeculectomy. INTERVENTION: All eyes underwent trabeculectomy with intraoperative MMC (0.25 mg/ml for 3 minutes) without either conjunctival or Tenon's touch. Patients were examined 1 month, 3 months, 6 months, and 12 months after surgery. Intraocular pressure (IOP) and number of medications were evaluated at each examination. The appearance of the bleb was classified at the last examination into one of three groups: flat and vascularized; elevated but not avascular; or elevated, thin, and avascular. MAIN OUTCOME MEASURES: Intraocular pressure, number of antiglaucoma medications, and appearance of the bleb. RESULTS: Preoperative mean IOP was 30.57 +/- 10.92 mmHG: Statistically significant IOP reductions were observed 1 month, 3 months, 6 months, and 1 year after surgery (P < 0.01). Twelve months after surgery, the mean IOP was 14.92 +/- 6.53 mmHG: Five eyes (33.3%) showed an IOP less than 15 mmHg without antiglaucoma medication at the 12-month examination. The bleb was considered elevated, thin, and avascular in 12 of 15 eyes (80%) at the end of follow-up. CONCLUSIONS: Intraoperative MMC at 0.25 mg/ml for 3 minutes without either conjunctival or Tenon's touch was not effective in eliminating the development of thin, avascular blebs in eyes undergoing primary trabeculectomy.

Low-dose mitomycin C trabeculectomy in patients with advanced glaucoma.

PURPOSE: The purpose of this study was to analyze the efficacy and safety of low-dose (0.2 mg/ml) intraoperative mitomycin C in primary trabeculectomy. METHODS: Twenty-eight eyes of 28 patients with advanced primary open-angle glaucoma undergoing primary trabeculectomy were randomized to either mitomycin C (0.2 mg/ml) or saline solution intraoperatively for 3 min. Intraocular pressure was measured at 1 day; 1 week; 1, 3, and 6 months postoperatively; and at the final visit. RESULTS: Mean follow-up was 17.0 +/- 5.6 months for the mitomycin C group and 15.7 +/- 5.1 months for the control group. Mean intraocular pressures were significantly lower in the treated group on the first postoperative day (p = 0.021), at the 6-month interval (p = 0.001), and at the final visit (p = 0.001). At the last follow-up examination, intraocular pressure was < or = 15 mm Hg in 12 (85.7%) of the mitomycin C-treated eyes and in four (28.6%) of the control eyes (p = 0.002). Life table analysis showed a significantly higher probability of intraocular pressure control in the mitomycin C group than in the control group (p = 0.0065). Choroidal effusion was observed in five (35.7%) treated eyes and two (14.3%) control eyes, whereas shallow anterior chamber were present in five (35.7%) treated eyes and one control eye (7.1%). CONCLUSION: Despite inducing a higher short-term complication rate, low-dose mitomycin C may be an alternative in the treatment of eyes with advanced glaucomatous damage requiring low final intraocular pressures.

Glaucoma agudo primario: estudo ecometrico pre e pos-operatorio a cirurgia de iridectomia periferica ou setorial. / Primary acute glaucoma: echographic study in the pre and postoperative period of peripheral or sectorial iridectomy

Os autores estudam ecometricamente 26 olhos acometidos de crise de glaucoma agudo primario discutindo particularmente a associacao dos valores da profundidade da camara anterior e do diametro axial antero-posterior do cristalino com relacao ao sucesso ou insucesso da cirurgia de iridectomia periferica.

Weill-Marchesani syndrome: a clinical and ultrasonographic study of two siblings.

Os autores apresentaram um estudo clinico e ecografigo de um irmao e sua irma ambos portadores da sindrome de Weill-Marchesani. A irma apresenta uma alteracao do segmento anterior em ambos os olhos, provavelmente devida seja a uma anteriorizacao-confirmada ecograficamente _ do cristalino com consequente aumento do diametro antero-posteior do espaco vitreo e diminuicao da profundidade da camara anterior, seja a uma disgenesia mesodermal nao caracteristica do segmento anterior

Efeito da pilocarpina nos resultados da prova da "prone position" en quarto escuro. / Effect of pilocarpine on the results of the prone position test in dark room

Os autores estudaram o efeito da pilocarpina 2% nos resultados da prova da"prone position" em quarto escuro em 10 olhos normais, contralaterais a olhos que sofreram crise de glaucoma agudo primario. Comenta-se a importancia destes achados no tratamento profilatico da crise aguda de fechamento angular

Iridectomia no glaucoma agudo primario.Resultados cirurgicos. / Iridectomy in acute primary glaucoma. Surgical results

25 olhos de 23 individuos foram estudados por um periodo de tempo de 3-24 meses (media 8 meses) por terem sido submetidos a iridectomia apos crise de glaucoma agudo. Possiveis parametros predictivos em relacao ao sucesso da iridectomia, como a duracao da crise, o valor da pressao intra ocular durante a crise e a presenca ou ausencia de glaukomflecken e atrofia de iris, foram analisados. 62,5% dos olhos e 91,6% dos olhos tiverem sucesso cirurgico respectivamente (pressao intra ocular 22 mmHg durante o periodo de seguimento) somente com a cirurgia e com o uso de pilocarpina 2% apos a mesma. Nao foi possivel se determinar nenhuma correlacao entre a duracao da crise ou os niveis de pressao intra ocular durante a mesma com o sucesso ou insucesso cirurgico. Contudo, apenas 42,8% dos olhos com atrofia setorial de iris, e ou glaucomflecken apresentaram apos a iridectomia pressoes intra oculares sem medicacao iguais ou inferiores a 22 mmHg em contraste com 81,8% do grupo sem estas alteracoes (diferenca estatisticamente significante x2 = 4.9 p <0,05

Celulite orbitaria. / Orbital cellulitis

Os autores realizam um estudo retrospectivo de 51 casos de celulite orbitaria que pela gravidade do quadro clinico necessitam internacao na Clinica Oftalmologica do Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, no periodo compreendido entre janeiro de 1970 e junho de 1980, e discutem dados gerais da patologia em questao, detalhando de modo especial os itens referentes a fatores desencadeantes, patologias associadas, complicacoes e procedimentos cirurgicos

Avaliacao da pressao intra-ocular no pos-operatorio do glaucoma agudo primario na ausencia de medicacao antihipertensiva. / Evaluation of intraocular pressure in the postoperative period of acute primary glaucoma without antihypertensive medication

Foram estudados 31 pacientes (42 olhos) iridectomizados por terem apresentado crise de glaucoma agudo primario. Tais pacientes foram acompanhados por um periodo de tempo de 2 a 48 meses. 45,2% dos olhos apresentarm PIO entre 20 - 50 mmHg nos dois primeiros meses de pos-operatorio. 5 dos 19 olhos (26,3%) tiveram suas pressoes intraoculares normalizadas com a simples suspensao do uso de esteroides e midriaticos topicos. 3 olhos que durante 17 meses apresentaram suas pressoes normalizadas apos a cirurgia, desenvolveram PIO de 26 a 30 mmHg apos este periodo. A importancia clinica destes achados e discutida

Alteracoes isquemicas e necroticas no glaucoma agudo primario. / Ischemic and necrotic changes in acute primary glaucoma

47 pacientes num total de 58 olhos, que apresentaram crise de glaucoma agudo foram estudados. Analisou-se a frequencia quanto ao sexo, raca e idade dos pacientes e a bilateralidade do comprometimento ocular. A frequencia no sexo feminino foi de 85,1%, sendo que somente 4,2% eram da raca negra. Nao foi possivel correlacionar-se a presenca de atrofia setorial da iris e glaukomflecken com a duracao ou valor da pressao intra ocular no momento da crise. A possibilidade de que a atrofia de iris precede o aparecimento de glaukomflecken na maioria dos pacientes e discutida