Perfil do diagnóstico inicial em pacientes com glaucoma / Profile of initial diagnosis in patients with glaucoma

RESUMO Objetivo Avaliar o estágio do glaucoma no momento de seu diagnóstico. Métodos Estudo transversal e descritivo, usando dados obtidos por meio de consultas ao banco de dados de pacientes glaucomatosos atendidos em sua primeira consulta, antes da instituição de quaisquer tratamentos. Resultados Foram incluídos 101 pacientes (177 olhos). Apenas 31 (30,69%) deles referiam história familiar positiva para glaucoma. Encontraram-se 26% dos olhos avaliados com alterações perimétricas avançadas, dez olhos (5,8%) com visão pior que 20/400 e, destes, três pacientes apresentavam cegueira legal em ambos os olhos. Os fatores associados à gravidade do glaucoma foram idade avançada e pressão intraocular elevada. Conclusão O conhecimento da situação no diagnóstico inicial retrata a realidade do glaucoma em nosso meio e prediz ações visando à prevenção da cegueira.

ABSTRACT Objective To assess the stage of the disease at the time of diagnosis. Methods Cross-sectional and descriptive study, using data obtained by searching the database of glaucoma patients in their first consultation, before the starting any treatment. Results 101 patients (177 eyes) were included. Only 31 (30.69%) patients reported a positive family history of glaucoma. We found 26% of the evaluated eyes with advanced perimetric alterations, ten eyes (5.8%) with vision worse than 20/400, of these, three patients had legal blindness in both eyes. Factors associated with glaucoma severity were advanced age and high IOP. Conclusion Knowledge of the situation in the initial diagnosis portrays the reality of glaucoma in our environment and predicts actions aimed at preventing blindness.

Association between Obstructive Sleep Apnea and Exfoliation Syndrome: The Utah Project on Exfoliation Syndrome.

PURPOSE: Exfoliation syndrome (XFS), the most common recognizable cause of open-angle glaucoma worldwide, is a systemic disorder with genetic predisposition due to variations in lysyl oxidase-like 1 (LOXL1) function, leading to altered elastin matrices in ocular and systemic tissues. Obstructive sleep apnea (OSA) is a highly prevalent disorder also involving elastic tissue dysfunction and is associated with glaucoma. Because of the similarities between the disorders, we sought to uncover any relationship in the prevalence of these diagnoses. DESIGN: Case-control, retrospective cohort study. PARTICIPANTS: A cohort of 81 735 patients diagnosed with OSA at ages 50 to 90 years was identified from medical records from 1996 to 2017 in the Utah Population Database. Case subjects were matched to random controls on sex and birth year in a 4:1 ratio. METHODS: International Classification of Diseases, Ninth Revision (ICD-9) codes or their Tenth Revision equivalent were used to define a diagnosis of OSA (ICD-9 327.23) and a diagnosis of XFS (ICD-9 365.52 and 366.11). Conditional logistic regression odds ratios (ORs) accounting for individual matching on sex and birth year were used to estimate the risk of XFS in patients with OSA. Models included adjustment for race, obesity, tobacco use, hypertension (HTN), atrial fibrillation (AF), and chronic obstructive pulmonary disease (COPD). MAIN OUTCOME MEASURE: Whether patients with OSA have an increased risk of diagnosis of XFS compared with controls without OSA. RESULTS: There was an increased risk of an XFS diagnosis in patients with OSA compared with non-OSA controls (OR, 1.27; 95% confidence interval [CI], 1.02-1.59; P = 0.03). In a stratification of patients by HTN diagnosis history, patients with OSA and HTN exhibited an increased risk of XFS compared with non-OSA controls with HTN (OR, 2.67; 95% CI, 2.06-3.46; P < 0.0001). CONCLUSIONS: Patients with OSA may be at an increased risk of XFS compared with patients without OSA, particularly in patients with a history of HTN.

Creation of a childhood glaucoma registry database / Criação de um banco de dados para glaucoma infantil

ABSTRACT Purpose: The aim is creation of a database to register patients diagnosed with childhood glaucoma. Information collection and storage will utilize a digital platform that permits multiple centers to register patients. This registry will be an important tool to evaluate and group patient profiles, thus allowing identification of risk factors, estimating prevalence, and recruiting participants in future studies. Methods: An online form was designed at the Department of Ophthalmology and Visual Sciences of the Federal University of São Paulo to create a registry of patients diagnosed with congenital glaucoma. In addition, a pilot study was conducted in the same institution to validate the Google Forms platform that comprises the registry questionnaire. Results: Data can be entered online and stored in the cloud. The database allows the acquisition and storage of epidemiological and clinical data, detection of patterns, and evaluation of the current treatment of children with childhood glaucoma. The data from multiple centers can be combined as collection in online and storage is in the cloud. The form is comprehensive and includes social data, gestational history, family history, clinical data on entering the center, and the treatment received. Conclusions: Google Forms is a useful tool for collecting and analyzing statistical data, facilitating the process of registering patients, and analyzing information. Using the online questionnaire, it will be possible to create a multicenter online database that allows identification of risk factors and evaluation of the outcome of interventions and treatment.

RESUMO Objetivo: Este estudo visa a criação de um programa para a formação de uma base de dados dos pacientes com diagnóstico de glaucoma pediátrico do Departamento de oftalmologia e ciências visuais da Universidade Federal de São Paulo. O armazenamento das informações se dará por meio de uma plataforma digital, possibilitando que outros centros também possam cadastrar pacientes. Este registro será uma ferramenta importante para avaliar o perfil dos pacientes e agrupá-los, permitindo identificar fatores de risco, estimar prevalência e recrutar indivíduos para futuras pesquisas. Métodos: Um formulário online foi projetado para criar um registro de pacientes com diagnóstico de glaucoma congênito do Departamento de Oftalmologia e Ciências Visuais da Universidade Federal de São Paulo. Além disso, um estudo piloto foi conduzido para validar a base de dados criada. Resultados: Foi criado um questionário usando a plataforma Google Forms, de preenchimento online e armazenamento na nuvem, para registro dos pacientes com diagnóstico de glaucoma infantil do Departamento de Oftalmologia e Ciências Visuais da Universidade Federal de São Paulo. Tal registro permite armazenar dados epidemiológicos e clínicos, detectar padrões e avaliar o tratamento atual de crianças com glaucoma da infância, com a possibilidade de intercâmbio e uso de informações com outros centros, já que a coleta e o armazenamento dos dados se dá de forma online. O formulário é extenso e engloba dados sociais, histórico gestacional, antecedentes familiares, dados clínicos de entrada no nosso centro e o tratamento recebido. Conclusão: Este estudo demonstrou que o Google Forms é uma ferramenta útil para coleta e análise de dados estatísticos, facilitando o processo de registro de pa­cientes e análise de informações. A criação do questionário online e a consequente análise das informações permitirá o maior conhecimento do perfil dos pacientes acompanhados em nosso centro e, com a centralização dos dados num ambiente único - nuvem digital - tornar-se-á possível criar um banco de dados online multicêntrico que permitirá a identificação de fatores de risco e avaliar o resultado das intervenções e tratamentos, assim como recrutar as crianças para pesquisas futuras.

The Eye, Oxidative Damage and Polyunsaturated Fatty Acids.

Polyunsaturated fatty acids (PUFA) are known to have numerous beneficial effects, owing to their anti-inflammatory and antioxidant properties. From a metabolic standpoint, the mitochondria play a fundamental role in cellular homeostasis, and oxidative stress can affect their functioning. Indeed, the mitochondria are the main source of ROS, and an imbalance between ROS and antioxidant defenses leads to oxidative stress. In addition, aging, the decline of cellular functions, and continual exposure to light underlie many diseases, particularly those of the eye. Long-term exposure to insults, such as UV light, visible light, ionizing radiation, chemotherapeutics, and environmental toxins, contribute to oxidative damage in ocular tissues and expose the aging eye to considerable risk of pathological consequences of oxidative stress. Ample antioxidant defenses responsible for scavenging free radicals are essential for redox homeostasis in the eye, indeed, eye tissues, starting from the tear film, which normally are exposed to high oxygen levels, have strong antioxidant defenses that are efficient for protecting against ROS-related injuries. On the contrary, instead, the trabecular meshwork is not directly exposed to light and its endothelial cells are poorly equipped with antioxidant defenses. All this makes the eye a target organ of oxidative damage. This review focuses on the role of the polyunsaturated fatty acids in the human eye, particularly in such pathologies as dry eye, glaucoma, and macular degeneration, in which dietary PUFA supplementation can be a valid therapeutic aid.

The role of phacoemulsification in glaucoma therapy: A systematic review and meta-analysis.

Cataract extraction is a safe and effective surgery that has been performed in its modern form for several decades. Many studies have noted that cataract extraction could also have a clinically significant role in the control of comorbid glaucoma. Lens extraction decreases the pressure within the eye, and intraocular pressure (IOP) is the only controllable risk factor in glaucoma proven to be effective. A systematic analysis of current evidence is needed to establish strong practice patterns and identify areas where further research is required. We performed systematic review and meta-analysis of the clinical data to estimate the net effect of cataract surgery on IOP. A total of 37 treatment arms from 32 different studies from January 1997 to January 2017 were included. IOP reduction was highly correlated across follow-up periods. For angle-closure glaucoma, results showed an IOP decrease of -6.4 mmHg (95% CI: -9.4 to -3.4) at final follow-up (12 months and longer). For the open-angle glaucoma group, there was an overall IOP change of -2.7 mmHg (95% CI -3.7 to -1.7) from baseline. For pseudoexfoliation glaucoma further research is needed to reach an adequate evidence-based conclusion. The influence of inherent sources of bias, including loss to follow-up, washout and medication use, and lack of a control group, was evaluated numerically. These sources of bias pulled the IOP estimate in opposite directions and are therefore unlikely to affect the main conclusions substantially. Future prospective clinical trials, including other outcomes such as quality of life, clinical severity information, and cost-effectiveness analysis, are needed to determine the role of phacoemulsification alone within the glaucoma treatment algorithm.

Perfil epidemiológico dos pacientes com glaucoma congênito atendidos no Hospital Regional de São José / Epidemiological profile of patients with congenital glaucoma treated in the Hospital Regional de São José

Objetivo Delinear um perfil epidemiológico de pacientes com glaucoma congênito atendidos no serviço de Oftalmologia do Hospital Regional de São José, bem como a evolução destes pacientes com os tratamentos empregados. Métodos Foi realizado um estudo longitudinal, retrospectivo, descritivo que avaliou 32 pacientes com glaucoma congênito atendidos em ambulatório, desde a primeira consulta quando ingressaram no serviço e consultaram pelo menos duas vezes no período de 1º de março de 2009 até 1º de fevereiro de 2011. Resultados Houve predominância do sexo feminino (59,37%). Com relação à lateralidade, ambos os olhos foram acometidos em 91% dos casos. A maioria dos pacientes (78,12%) apresentava glaucoma congênito primário. Oitenta e cinco cirurgias foram realizadas para o glaucoma congênito, destes 63,52% foram submetidos à trabeculotomia. A pressão intraocular aferida na primeira e na última consulta diminuiu em 85,93% dos 64 olhos, já em relação à pressão intraocular média houve uma diminuição de 82,81% em relação ao valor na primeira consulta. Ao realizar a comparação do diâmetro corneano horizontal da primeira consulta em relação à última, bem como da primeira consulta em relação à média das aferições de todas as consultas, em 25,42% ocorreu aumento. Conclusão Nos pacientes com glaucoma congênito, houve predomínio do acometimento bilateral e do sexo feminino. A maioria dos pacientes apresentou diminuição da pressão intraocular na última consulta em relação à primeira e em poucos pacientes houve um aumento do diâmetro corneano horizontal...

Objective To outline an epidemiological profile of patients with congenital glaucoma treated in the ophthalmology service, as well as the evolution of these patients with the treatment adopted. Methods A longitudinal, retrospective, descriptive study was undertaken in order to evaluate 32 patients with congenital glaucoma treated in the clinic, from the first consultation in which they entered the service and who attended the clinic at least two times in the period from march 1st, 2009 to february 1st, 2011. Results There was a predominance of female patients (59.37%). In relation to the lateralization, both eyes were affected in 91% of the cases. Most patients (78.12%) presented primary congenital glaucoma. Eighty-five surgeries were performed for congenital glaucoma, 63.52% of them were submitted to trabeculotomy. The intraocular pressure measured in the first and in the last consultation diminished in 85.93% of the 64 eyes, and in relation to the mean intraocular pressure there was a decrease of 82.81% in relation to the value of the first consultation. When making the comparison of the horizontal corneal diameter of the first consultation in relation to the last one, as well as of the first consultation in relation to the average of the measurements of all consultations, in 25.42% there was an increase. Conclusion In the patients with congenital glaucoma, there was a predominance of bilateral involvement and of female patients. Most patients presented a decrease of intraocular pressure in the last consultation in relation to the first one, and in a few patients there was an increase of horizontal corneal diameter...

Conhecimento da população sobre glaucoma e perfil epidemiológico em campanha realizada no Hospital Universitário Lauro Wanderley / Knowledge about glaucoma and epidemiological profile of subjects seen in a campaign conducted at the University Hospital Lauro Wanderley

Objetivo: Avaliar o nível de conhecimento sobre glaucoma numa população aleatoriamente selecionada, assim como correlacionar com dados epidemiológicos e sócio-culturais. Métodos: Foi realizado um estudo transversal analítico, por meio da aplicação de questionários, contendo perguntas gerais sobre glaucoma, a pacientes participantes de uma campanha para esclarecimento e prevenção da doença. Resultados: Dos 200 entrevistados, 54,5% eram do sexo feminino e 45,5% do sexo masculino, com média de idade 51 anos e 11 meses. No tocante à raça, 54% são pardos, 29% brancos e 17% negros. 85% referiram já ter feito exame oftalmológico em outra ocasião. Com relação à escolaridade, 5% nunca estudaram, 22,5% estudaram da 1ª a 4ª série, 15% da 5ª a 8ª série , 45% tinham ensino médio e 14,5% ensino superior. Quando interrogados, apenas 32%(64) dos pacientes relataram conhecer a doença e destes 71,87%(46) afirmaram ser o glaucoma uma patologia que não tem cura, mas sim controle e 48,4%(31) possuíam casos de glaucoma na família.Com relação ao tratamento, entre os que conheciam a doença, 64%(41) pacientes dizem saber como se trata, afirmando ser o colírio a principal forma de tratamento. A análise dos dados permitiu concluir também que o grupo de escolaridade do ensino médio possuía a maior proporção dos entrevistados que afirmaram conhecer o glaucoma, correspondendo a 69% destes. Conclusão: Corroborando com esses fatores, que consistem em barreiras para o diagnóstico e fidelidade do paciente ao tratamento, o presente trabalho verificou a real existência da desinformação por parte da população sobre o glaucoma, suas complicações, tratamento e métodos para o diagnóstico. Estudos ...

Objective: To evaluate the level of knowledge about glaucoma in a population randomly selected, so as to correlate with epidemiological and socio-cultural. Methods: We conducted a transversal analytical study by means of questionnaires containing general questions about glaucoma, patients participating in a campaign for awareness and prevention of glaucoma. Results: Of 200 respondents, 54.5% were female and 45.5% male, mean age 51 years and 11 months. Regarding race, 54% are brown, 29% white and 17% were black. 85% reporting having eye exam at another time. With respect to education, 5% never attended school, 22.5% had studied the first to fourth grade, 15% of 5th to 8th grade, 45% had completed high school and 14.5% higher. When asked, only 32% (64) of patients reported knowing the disease and of these 71.87% (46) claimed to be a pathology that glaucoma has no cure, but control and 48.4% (31) had glaucoma cases in the family. With regard to treatment, among those who knew the disease, 64% (41) patients say how it comes, saying it drops the main form of treatment. Data analysis also concluded that the group of high school education had the highest proportion of respondents who said they knew glaucoma, accounting for 69% of these. Conclusion: Corroborating these factors, which consist of barriers to diagnosis and fidelity to treatment, this study examined the actual existence of misinformation from the public about glaucoma, its complications, treatment and methods for diagnosis. The available literature found that patients with less education were more about the ignorance of his condition, this information was also verified in this study. Proved insufficient knowledge about glaucoma, the forms of prevention and treatment. This suggests the need for educational activities aimed at disseminating knowledge of glaucoma among patients and the general population, as a way to prevent vision loss. .

Análise dos fatores de risco e epidemiologia em campanha de prevenção da cegueira pelo glaucoma em João Pessoa, Paraíba / Analysis of risk factors and epidemiology of blindness prevention campaign by glaucoma in João Pessoa, Paraíba

OBJETIVO: Este trabalho tem por objetivo avaliar a incidência dos fatores de risco em uma amostra da população, avaliada durante uma campanha de prevenção da cegueira pelo glaucoma, bem como analisar os dados epidemiológicos sobre a ocorrência de casos suspeitos de glaucoma na cidade de João Pessoa, Paraíba. MÉTODOS: Após prévia divulgação, pessoas com idade ≥ 40 anos, compareceram voluntariamente ao Hospital Universitário Lauro Wanderley, João Pessoa, Paraíba. Realizou-se anamnese, medida da pressão intraocular (PIO) com tonômetro de aplanação de Goldmann e biomicroscopia de fundo. Considerados suspeitos aqueles com PIO ≥ 21 mmHg ou disco óptico com relação escavação sobre disco (E/D) ≥ 0,5 x 0,5. Os suspeitos foram subdivididos por idade, sexo e tipo de alteração e divididos em: Grupo I de 40 e 49 anos; Grupo II de 50 e 59 anos; Grupo III ≥ 60 anos; P+ se apenas PIO Analysis of risk factors and epidemiology of blindness prevention campaign by glaucoma in João Pessoa, Paraíba 21 mmHg; E/D+ se apenas E/D ≥ 0,5x0,5; e P/E/D+ quando ambos alterados. RESULTADO: No total de 244 pacientes, 29,50% foram considerados suspeitos (48,61% homens (H) e 51,38% mulheres(M), sendo 41,66% pertencentes ao Grupo I; 23,61% ao Grupo II e 34,72% ao Grupo III. Com relação ao tipo de alteração: 70,83% eram E/D+; 15,27% eram P+ e 13,88% P/E/D+. Foi ainda realizada uma análise detalhada entre homens e mulheres. CONCLUSÃO: Apesar da irreversibilidade das alterações conseqüentes ao glaucoma, o diagnóstico precoce e o tratamento adequado, associado à conscientização da população, são capazes de prevenir cegueira, comprovando a importância da realização periódica dessas campanhas.

OBJECTIVE: This study aims evaluating the incidence of risk factors in a population sample, assessed during campaign of prevention of blindness by glaucoma, and analyzing epidemiological data incidence of glaucoma in the city of João Pessoa (PB). METHODS: After prior disclosure, individuals aged≥ 40 years, attended voluntarily at Lauro Wanderley University Hospital, Joao Pessoa (PB) for examination, anamnesis, intraocular pressure (IOP) measured by applanation tonometer of Goldmann, and direct fundoscopy. Those who were considered suspect showed IOP ≥ 21 mmHg or/and a cup to disc ratio (CDR) ≥ 0,5. The cases suspects were separated by age, sex and abnormal signs. We referred to Group I individuals from 40 to 49 years old, Group II from 50 to 59 years old, Group III ≥ 60 years, "P+" for IOP ≥ 21 mmHg, "E/ D+" for CDR ≥ 0.5 and "P/E/D+" for individuals with all the showing signs. RESULTS: Within a total of 244 patients, 29.50% were considered suspects (48.61% male, 51.38% female, and 41.66% of group I, 23.61% of Group II and 34.72% of Group III). Regarding the type of sign: 70.83% were E/D+, 15.27% were P+ and 13.88% were P/ E/D+. There was also carried out a detailed analysis of men and women. CONCLUSION: Despite the irreversibility of the modifications caused by glaucoma, early diagnosis and proper treatment associated with raising awareness of population are preventive actions to inhibit blindness, confirming the relevance of conducting periodic preventive campaigns.