RESUMO
PURPOSE: To compare provocative test-based and long-term intraocular pressure variation parameters in patients with stable open-angle glaucoma. METHODS: A prospective observational study was carried out in which stable open-angle glaucoma patients (⩾3 years of follow-up without any changes on current medical regimen) were consecutively enrolled. All patients were submitted to a water-drinking test. Long-term intraocular pressure parameters were obtained from isolated intraocular pressure measurements from each visit (⩾5 visits). We investigated the correlation and agreement between the following water-drinking test and long-term intraocular pressure parameters: mean, peak, and fluctuation. In addition, the percentage of eyes with significant intraocular pressure peaks during the water-drinking test (defined as a difference ⩾25% between water-drinking test intraocular pressure peak and mean long-term intraocular pressure) was assessed. RESULTS: Sixty-three eyes from 63 open-angle glaucoma patients (mean age, 60.7 ± 11.8 years) were included. Mean and water-drinking test intraocular pressure peak correlated significantly with mean (r = 0.67) and maximum long-term intraocular pressure (r = 0.52), respectively (p < 0.01). The correlation between water-drinking test intraocular pressure fluctuation and long-term intraocular pressure fluctuation was not significant (p = 0.45). Limits of agreement from Bland-Altman plots exceeded the maximum allowed difference between methods (3 mm Hg) for all the intraocular pressure parameters analyzed, suggesting poor agreement between water-drinking test-derived and long-term intraocular pressure values. Overall, significant water-drinking test intraocular pressure peaks were observed in 39.7% of these eyes with stable open-angle glaucoma. CONCLUSION: Although some water-drinking test-based and long-term intraocular pressure parameters correlate significantly, water-drinking test results may not reflect the long-term intraocular pressure profile of stable open-angle glaucoma patients, as their agreement is poor. Many of these patients may experience significant water-drinking test intraocular pressure peaks, despite long-standing stable disease and unchanged medical regimen.
Assuntos
Técnicas de Diagnóstico Oftalmológico , Água Potável/administração & dosagem , Glaucoma de Ângulo Aberto/fisiopatologia , Pressão Intraocular/fisiologia , Idoso , Humor Aquoso/fisiologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Tonometria Ocular/métodosRESUMO
RESUMO A hipertensão ocular aguda durante a hemodiálise constitui evento raro e pode ser causa relevante de interrupção do tratamento dialítico devido à dor. Relata-se o caso de um paciente de 70 anos de idade, do sexo masculino, que apresentou quadros recorrentes de intensa dor ocular unilateral durante sessões dialíticas devido ao aumento de pressão intraocular. O paciente era portador de grave diminuição da acuidade visual no olho direito devido a glaucoma neovascular, controlado com medicação hipotensora tópica. Uma hora após o início da sessão dialítica, apresentou dor excruciante no olho direito, sendo necessário interromper o tratamento por diversas vezes. A dor somente era amenizada com uso de opioides por via endovenosa ou após cerca de 6 horas do procedimento. Injeção intraocular de drogas antiangiogênicas e acetazolamida por via oral, assim como tratamentos tradicionais para quadros agudos de hipertensão intraocular, como uso de hipotensor tópico e medicamentos hiperosmolares, foram insuficientes para o controle da dor. O problema se resolveu com ciclofotocoagulação transescleral realizada com laser diodo, com redução da pressão intraocular basal e controle da dor, o que permitiu a realização de sessões completas de hemodiálise. A base fisiopatológica desse evento incomum e suas opções terapêuticas são discutidas aqui.
ABSTRACT Acute ocular hypertension during hemodialysis is a rare event and may lead to interruption of dialytic therapy due to pain. A case of a 70-year-old male patient is reported, who presented recurrent intense unilateral ocular pain episodes during dialysis sessions for increased intraocular pressure. The patient presented with severely decreased visual acuity in the right eye due to neovascular glaucoma, which was controlled with topical hypotensive medication. One hour after initiating dialysis, he presented an excruciating pain on the right eye, which required interruption of treatment several times. Pain relief was possible only with intravenous opioids, or approximately 6 hours after dialysis. Intraocular injection of antiangiogenic drugs and per oris acetazolamide, as well as other traditional treatments for acute episodes of intraocular hypertension, such as topical antihypertensive agents and hyperosmotic medications, were not sufficient to control pain. The problem was solved with transscleral diode laser cyclophotocoagulation, which reduced baseline intraocular pressure and controlled pain, enabling complete hemodialysis sessions. The pathophysiological aspects and therapeutic options of this unusual condition are discussed.
Assuntos
Humanos , Masculino , Idoso , Glaucoma Neovascular/complicações , Hipertensão Ocular/etiologia , Diálise Renal/efeitos adversos , Pressão Intraocular , Concentração Osmolar , Humor Aquoso/fisiologia , Soluções para Diálise , Insuficiência Renal Crônica/terapia , Dor AgudaRESUMO
OBJECTIVE: To assess the feasibility of a novel surgical technique in painful blind eyes. DESIGN: A prospective safety study conducted at the Federal University of Minas Gerais, Brazil. PARTICIPANTS/SAMPLES: A total of 15 end-stage glaucomatous eyes without light perception vision. METHODS: After implantation, conjunctival hyperemia, discharge, erosion, aqueous humor leakage, corneal edema, hyphema, anterior chamber cells and depth, dislocation of the implant, and filtering bleb height were assessed by slit-lamp biomicroscopy. Intraocular pressure was measured preoperatively and 24 months following surgery. A numerical rating scale was used to evaluate pain. Anterior segment optical coherence tomography was also assessed. RESULTS: Laminar drainage implant surgery was performed in all patients without major complications. Mean intraocular pressure was significantly reduced after surgery without hypotensive medication (preoperatively 54.5 ± 5.1 mmHg vs 24 months after surgery 37.0 ± 15.4 mmHg, p = 0.003). Subjective ocular pain intensity also reduced (preoperatively 10 vs at 24-month follow-up visits 0). Corneal edema incidence reduced from 85.7% (95% confidence interval: 57.2%-98.2%) to 16.7% (95% confidence interval: 2.1%-48.4%) at the 24-month follow-up. No patients experienced a prolonged flat anterior chamber or erosion of overlying tissues. CONCLUSION: The surgery was feasible and safe in painful blind eyes.
Assuntos
Câmara Anterior/cirurgia , Implantes para Drenagem de Glaucoma , Glaucoma/cirurgia , Implantação de Prótese/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Humor Aquoso/fisiologia , Cegueira/prevenção & controle , Edema da Córnea/fisiopatologia , Dor Ocular/fisiopatologia , Estudos de Viabilidade , Feminino , Glaucoma/fisiopatologia , Humanos , Pressão Intraocular/fisiologia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Estudos Prospectivos , Tomografia de Coerência Óptica/métodos , Tonometria OcularRESUMO
PURPOSE: To evaluate the in vitro antimicrobial activity of aqueous humor in patients who had preoperative topical application of moxifloxacin hydrochloride 0.5%. SETTING: Department of Ophthalmology, Santa Casa de Misericórdia de São Paulo, Brazil. DESIGN: Comparative case series. METHODS: Twenty-nine eyes from 29 cataract surgery patients were included in this study. In the study group (n = 15 eyes), 3 topical applications of moxifloxacin hydrochloride 0.5% were administered preoperatively; in the control group (n = 14 eyes), no topical applications were administered. Aqueous humor samples were collected and stored in sterile microtubes at -80°C until analysis. Antimicrobial analysis was performed using standard strains with standard sterile filter paper disks. Inhibition halos were measured in millimeters, and both bactericidal and bacteriostatic effects were analyzed. RESULTS: Inhibition halos were observed on most of the study group plates except those with Streptococcus pneumoniae: Escherichia coli (13.93 mm ± 0.64 [SD]), Klebsiella pneumoniae (10.63 ± 0.61 mm), Staphylococcus aureus (7.47 ± 0.68 mm), and S epidermidis (4.20 ± 3.33 mm) The differences between the mean inhibition halo diameters were statistically significant (P < .0001) in all samples. No bactericidal effect was observed against any of the microorganisms studied. CONCLUSIONS: After topical application of moxifloxacin 0.5%, aqueous humor showed bacteriostatic effect against E coli, K pneumoniae, S aureus, and S epidermidis. No bactericidal effect was observed against any of the microorganisms evaluated. No antimicrobial effect against S pneumoniae was observed. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.
Assuntos
Antibacterianos/administração & dosagem , Humor Aquoso/fisiologia , Bactérias/crescimento & desenvolvimento , Extração de Catarata , Fluoroquinolonas/administração & dosagem , Administração Tópica , Idoso , Idoso de 80 Anos ou mais , Bactérias/efeitos dos fármacos , Escherichia coli/efeitos dos fármacos , Escherichia coli/genética , Humanos , Klebsiella pneumoniae/efeitos dos fármacos , Klebsiella pneumoniae/crescimento & desenvolvimento , Testes de Sensibilidade Microbiana , Moxifloxacina , Soluções Oftálmicas , Staphylococcus aureus/efeitos dos fármacos , Staphylococcus aureus/crescimento & desenvolvimento , Staphylococcus epidermidis/efeitos dos fármacos , Staphylococcus epidermidis/crescimento & desenvolvimento , Streptococcus pneumoniae/efeitos dos fármacos , Streptococcus pneumoniae/crescimento & desenvolvimentoRESUMO
PURPOSE: To determine whether there is a circadian change of the concentration of C-type natriuretic peptide (CNP) in rabbit aqueous humor. METHODS: Forty-one male white New Zealand rabbits were submitted to a 12 h light and 12 dark lighting schedule; lights on was at 0 h, lights off at 12 h. C-type natriuretic peptide was assayed at 3 light (2 h, 6 h and 10 h) and 3 dark (14,18 and 22 h) times. All groups consisted of four animals but two had more animals to increase the power of tests (6 h, n = 12; 22 h, n = 13). Dependence between the two eyes was tested by Pearson's correlation. The mean of two eyes was considered for analysis. Differences in concentration in pg/200 ml were evaluated by one-way ANOVA, t test and COSINOR analysis. RESULTS: There were no significant differences between the 6 analyzed groups (one-way ANOVA p = 0.157). Pooled into two groups (light and dark), the C-type natriuretic peptide concentration of the light group was lower, 2.626 +/- 0.92 pg/200 ml compared with the dark group 3.02 +/- 1.16 pg/200 ml but did not reach a significant difference (t test; p = 0.23). COSINOR analysis was not statistically significant (R% = 7.72 p = 0.209). CONCLUSION: These data demonstrate that the concentration of CNP in aqueous humor did not show a statistically significant circadian change in rabbits entrained to a 12 h light: 12 h dark lighting schedule.
Assuntos
Humor Aquoso/química , Ritmo Circadiano/fisiologia , Peptídeo Natriurético Tipo C/análise , Análise de Variância , Animais , Humor Aquoso/fisiologia , Escuridão , Pressão Intraocular/fisiologia , Luz , Masculino , Modelos Animais , CoelhosRESUMO
PURPOSE: To determine whether there is a circadian change of the concentration of C-type natriuretic peptide (CNP) in rabbit aqueous humor. METHODS: Forty-one male white New Zealand rabbits were submitted to a 12 h light and 12 dark lighting schedule; lights on was at 0 h, lights off at 12 h. C-type natriuretic peptide was assayed at 3 light (2 h, 6 h and 10 h) and 3 dark (14,18 and 22 h) times. All groups consisted of four animals but two had more animals to increase the power of tests (6 h, n=12; 22 h, n=13). Dependence between the two eyes was tested by Pearson's correlation. The mean of two eyes was considered for analysis. Differences in concentration in pg/200 ml were evaluated by one-way ANOVA, t test and COSINOR analysis. RESULTS: There were no significant differences between the 6 analyzed groups (one-way ANOVA p=0.157). Pooled into two groups (light and dark), the C-type natriuretic peptide concentration of the light group was lower, 2.626±0.92 pg/200 ml compared with the dark group 3.02±1.16 pg/200 ml but did not reach a significant difference (t test; p=0.23). COSINOR analysis was not statistically significant (R percent=7.72 p=0.209). CONCLUSION: These data demonstrate that the concentration of CNP in aqueous humor did not show a statistically significant circadian change in rabbits entrained to a 12 h light: 12 h dark lighting schedule.
OBJETIVO: Verificar se há mudança na concentração circadiana de peptídeo natriurético tipo C (CNP) no humor aquoso de coelhos. MÉTODOS: Quarenta e um coelhos machos da raça New Zealand foram admitidos numa rotina de 12 horas de luz e 12 de escuridão; luzes eram acesas na hora zero e apagadas na hora 12. O peptídeo natriurético tipo C era medido em três períodos com luz acesa (2, 6 e 10 h) e 3 com luz apagada (14, 18 e 22 h). Todos os grupos tinham 4 animais com exceção de dois períodos em que o n foi incrementado para aumentar o poder dos testes (6 h, n=12; 22 h, n=13). A dependência entre os olhos foi testada por meio da correlação de Pearson. A média dos dois olhos foi usada para a análise. Diferença quanto à concentração média de peptídeo natriurético tipo C em pg/200 ml foi avaliada por meio do teste de one-way ANOVA, teste t e análise de COSINOR. RESULTADOS: Não foi encontrada diferença estatisticamente significante entre os 6 grupos analisados (one-way ANOVA; p=0,157). Reunidos em dois grupos (luz e escuridão), a concentração de peptídeo natriurético tipo C com a luz acesa foi mais baixa (2,626±0,92 pg/200 ml) quando comparada ao grupo com luz apagada (3,02±1,16 pg/200 ml) porém sem alcançar significância estatística (teste de t p=0,23). Análise de COSINOR não foi estatisticamente significante (R por cento=7,72 p=0,209). CONCLUSÃO: Nossos dados demonstraram que a concentração do CNP no humor aquoso de coelhos não mostrou variação circadiana estatisticamente significante quando analisadas num ritmo de luz/escuro 12/12 h.
Assuntos
Animais , Masculino , Coelhos , Humor Aquoso/química , Ritmo Circadiano/fisiologia , Peptídeo Natriurético Tipo C/análogos & derivados , Análise de Variância , Humor Aquoso/fisiologia , Escuridão , Pressão Intraocular/fisiologia , Luz , Modelos AnimaisRESUMO
There are species-related anatomical differences in the ciliary muscle of the avian eye. The arrangement of muscular fibers in the avian eye is not well defined. To clarify this situation, we studied the architecture of ciliary muscle of Gallus domesticus by light and scanning electron microscopy (SEM). Our results showed the existence of three main muscular groups that we defined as anterior, posterior, and intermediary. These muscle divisions correspond to the description of the ciliary muscle as previously stated by Crampton (1813), Brucke, and Muller (1856). The striated fibers have a meridian orientation. The anterior and posterior muscular groups are inserted in the sclera, around the Schlemm's canal wall and ciliary process stroma. The vitreal intermediary muscle has fibers inserted in Schlemm's canal wall and ciliary process stroma. The framework of these muscular fibers may according to its insertions participate in the visual accommodation mechanism and outflow of the aqueous humor system.
Assuntos
Humor Aquoso/citologia , Corpo Ciliar/ultraestrutura , Olho/ultraestrutura , Músculo Liso/ultraestrutura , Animais , Humor Aquoso/fisiologia , Galinhas , Músculo Liso/cirurgiaRESUMO
PURPOSE: To determine the relationship between saccadic eye movements and the development of early postoperative capsular block syndrome. SETTING: Fundacion Oftalmologica, Los Andes, Santiago, Chile. METHODS: An artificial experimental setup was designed to reproduce the anatomical, hydrodynamic, and kinetic conditions of an early postoperative pseudophakic eye with a capsulorhexis and intracapsular intraocular lens (IOL) implantation. An electromechanical transducer driven by a digital-to-analog converter was used to mimic saccadic eye movements at physiological speeds and accelerations. Position information and differential pressure measurements between the intracapsular space and the extracapsular space were digitized. Various anterior capsule-IOL configurations were tested including partial adhesion of the anterior capsule to the lens. RESULTS: Saccadic movements increased intracapsular pressure by displacing fluid into the capsular bag. This finding was inconstant and only observed when the capsular rim adhered to the IOL optic by more than 70%. Development of positive intracapsular pressure was noted above 4 mm Hg. CONCLUSION: A valve-like mechanism formed by the capsulorhexis rim partially adhered to the IOL optic can occur postoperatively. Under these conditions, saccadic eye movements can increase intracapsular pressure by a unidirectional inertial displacement of fluid into the capsular bag.
Assuntos
Capsulorrexe/efeitos adversos , Cápsula do Cristalino/patologia , Doenças do Cristalino/etiologia , Lentes Intraoculares/efeitos adversos , Movimentos Sacádicos , Humor Aquoso/fisiologia , Humanos , Técnicas In Vitro , Pressão Intraocular , Doenças do Cristalino/patologia , Doenças do Cristalino/fisiopatologia , Modelos Anatômicos , Síndrome , Aderências TeciduaisRESUMO
Com o objetivo de analisar, qualitativa e quantitativamente, o conteúdo protéico do humor aquoso de portadores de síndrome de exfoliaçäo (EXF) e compará-lo com o de näo portadores da síndrome, foram selecionados 40 indivíduos (22 portadores e 18 näo portadores de EXF, com indicaçäo de tratamento cirúrgico de cataratae/ou glaucoma em pelo menos um dos olhos) que tiveram seu humor aquoso colhido , por ocasiäo no ato operatório. Utilizando o método de BRADFORD para quantificaçäo de proteínas totais no humor aquoso de portadores de EXF foi maior que nos dos näo portadores da síndrome (p<0,005). Observou-se também que a concentraçäo média de proteínas totais, nos portadores de EXF associada a glaucoma, foi maior que nos portadores de glaucoma primário de ângulo aberto (p<0,005). O mesmo ocorreu com relaçäo à concentraçäo média de proteínas totais do humor aquoso de portadores de EXF associada a catarata em comparaçäo com a dos portadores de catarata (p<0,025). Utilizando a técnica de eletroforese de proteínas em gel de poliacrilamida , com gradiente de 8 a 25 por cento na presença de SDS, a revelaçäo pela prata com as unidades de eletroforese e de revelaçäo do PhastSystem, respectivamente, observou-se, em 100 por cento dos membros de ambos os grupos estudados, a presença de uma única banda, bem definida e situada na regiäo correspondente 67 quilodaltons, a albumina. Após a separaçäo parcial da albumina com Affie-Gel blue, nenhuma outra proteína foi identificada em nenhum das amostras de humor aquoso de ambos de ambos os grupos.
Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Humor Aquoso/fisiologia , Síndrome de Exfoliação , Proteínas/análise , Estudos de Avaliação como Assunto , Estudos de Avaliação como Assunto , Idoso de 80 Anos ou mais , Eletroforese em Gel de Poliacrilamida , Extração de Catarata/métodos , Glaucoma/cirurgiaRESUMO
Utilizando a técnica de Lowry de quantificaçäo de proteínas, a técnica de Laemli de eletroforese em gel de poliacrilamida e a técnica de Oakley et al. de coloraçäo pela prata, ananlisou-se quantitativa e qualitativamente o conteúdo protéico do humor aquoso de 32 pacientes que iriam ser submetidos a cirurgia oftálmica: 18 portadores de catarata senil e 14 portadores de glaucoma primário de ângulo aberto. Verificou-se que a média da concentraçäo protéica total do grupo e portadores de catarata senil era 20, 546 mg por cento e a do grupo de portadores de glaucoma primário de ângulo aberto 19,356 mg por cento, näo havendo diferença estatisticamente significante entre elas. Foram encontradas oito proteínas no grupo de portadores de catarata senil e nove no grupo de portadores de glaucoma primário de ângulo aberto, em número variável de pacientes. A única proteína encontrada em todas as amostras de humor aquoso, dos dois grupos, foi a de 67 quilodautons, a albumina. A proteína com peso molecular de 150 quilodaltons foi encontrada somente no grupo de portadores de glaucoma primário de ângulo aberto, em 57,1 por cento das amostras e a de 190 quilodaltons em 85,7 por cento dos portadores de glaucoma primário de ângulo aberto e em 16,6 por cento das amostras de portadores de catarata senil.