Glaucoma Service

Belo Horizonte, Brazil

Glaucoma Service

Belo Horizonte, Brazil
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Suzuki Jr. E.R.,Glaucoma Service | Suzuki C.L.B.,Glaucoma Service | Carlier D.,Glaucoma Service | Penha D.,Glaucoma Service | And 2 more authors.
Clinical Ophthalmology | Year: 2012

Background: The purpose of this study was to determine any difference in dynamic contour tonometry and ocular pulse amplitude in asymmetric glaucoma patients with the same applanation intraocular pressure. Methods: This is a prospective, observational study of 30 glaucoma patients and 11 controls from June 2007 to February 2008. Most of the glaucoma patients were on prostaglandin analog treatment. Results: Mean applanation intraocular pressure in the control group was 14.28 mmHg for the right eye and 14.10 mmHg for the left eye (P > 0.05). Corneal thickness was 519.10 μm for the right eye and 511.07 μm for the left eye (P > 0.05). Mean dynamic contour tonometry intraocular pressure was 17.28 mmHg for the right eye and 17.25 mmHg for the left eye (P > 0.05). Mean ocular pulse amplitude was 2.80 mmHg for the right eye and 2.92 mmHg for the left eye (P > 0.05). Conclusion: No differences in ocular pulse amplitude were found between the two groups and between the worst and the best eye. In spite of there being no difference in ocular pulse amplitude, dynamic contour tonometry intraocular pressure was 2.44 mmHg higher in the worst eye than in the best eye in the glaucoma patients, even with the same applanation intraocular pressure. Further studies are needed to confirm if this difference is related to glaucoma progression or a worst prognosis and whether it can be considered to be a new risk factor. © 2012 Suzuki et al, publisher and licensee Dove Medical Press Ltd.


Costa V.P.,University of Campinas | Marcon I.M.,Glaucoma Service | Filho R.P.G.,Institute Olhos do Recife | Malta R.F.S.,University of Sao Paulo
Arquivos Brasileiros de Oftalmologia | Year: 2013

Purpose: To examine the prevalence of ocular surface complaints in Brazilian patients with glaucoma or ocular hypertension who used topical intraocular pressure (IOP)-lowering regimens. Methods: In this multicenter, noninterventional, single-visit study, adults with glaucoma or ocular hypertension treated with an IOP-lowering regimen were administered the 12-item ocular surface disease index (OSDI) questionnaire. Each response was scored on a 5-point scale, with 0 indicating symptom present none of the time and 4 indicating symptom present all of the time. The average of the 12 item responses for each patient was transformed to a scale from 0 to 100, with higher scores representing worse disabilities. OSDI results then were categorized as absence of OSD (scores of 0-12), mild OSD (scores of 13-22), moderate OSD (scores of 23-32), or severe OSD (scores of 33100). Results: The 173 enrolled patients had a mean age of 61.2 years, were women in 65.3% of cases, and had glaucoma in 89.0% of cases and ocular hypertension in 11.0% of cases. OSDI scores for 158 patients using 1 IOP-lowering therapy indicated no OSD in 37.3% of patients (59/158), mild OSD in 20.9% (33/158), moderate OSD in 17.1% (27/158), and severe OSD in 24.7% (39/158). For the 120 patients using 1 IOP-lowering medication and having a known duration of diagnosis of glaucoma or ocular hypertension, mean OSDI scores were numerically higher (worse) for the 39 patients with a diagnosis =6 years long (score 25 [± 20], indicating moderate OSD) than for the 81 patients with a diagnosis lasting <6 years (score 22 [± 20], indicating mild OSD); however, no significant differences in OSDI scores by duration of diagnosis were evident in means (P=0.49), distributions (P=0.26), or correlation (P=0.77). Conclusions: A large proportion of Brazilian patients treated with 1 IOP-lowering therapy had some ocular surface complaints.


To determine the spectrum of CYP1B1 gene mutations in Brazilian patients with primary congenital glaucoma, and to correlate the presence of alterations in the CYP1B1 gene sequence with clinical aspects of the disease. Thirty nonrelated patients with primary congenital glaucoma were studied. Molecular analysis consisted of the codifying region sequencing (exons 2 and 3) and intron/exon boundaries. CYP1B1 gene mutations were present in 9 (30%) of the 30 patients. The structural changes in the CYP1B1 gene previously described in the literature and observed in our study were Q19X, P437L, A443G, g.4340delG, g.7901_79013delGAGTGCAGGCAGA, g.8182delG, and g.8214_8215delG. Three new mutations were observed: 4635delT, 4523delC, and L378Q, in addition to 3793T→C, R48G, A119S, L432V, D449D, and N453S polymorphisms. Patients carrying CYP1B1 gene mutations needed more surgical procedures to control intraocular pressure, either when both eyes were evaluated (P=0.003) or when the worst eye of the patient was analyzed (P=0.011). In relation to the number of affected eyes, all patients with mutations (n=9/9) developed bilateral glaucoma, whereas 11/21 patients without mutations in the CYP1B1 gene had bilateral glaucoma (P=0.013). In this group of primary congenital glaucoma patients, a 30% mutation frequency in the CYP1B1 gene was observed. The presence of mutations was associated with a more severe form of the disease, requiring more surgeries for intraocular pressure control and with a higher rate of bilateral cases.


Tejwani S.,Glaucoma Service | Shetty R.,Refractive Surgery | Kurien M.,Cataract Surgery | Dinakaran S.,Glaucoma Service | And 2 more authors.
PLoS ONE | Year: 2014

Purpose: In this study, spectral analysis of the deformation signal from Corvis-ST (CoST) and reflected light intensity from ocular response analyzer (ORA) was performed to evaluate biomechanical concordance with each other. Methods: The study was non-interventional, observational, cross-sectional and involved 188 eyes from 94 normal subjects. Three measurements were made on each eye with ORA and CoST each and then averaged for each device. The deformation signal from CoST and reflected light intensity (applanation) signal from ORA was compiled for all the eyes. The ORA signal was inverted about a line joining the two applanation peaks. All the signals were analyzed with Fourier series. The area under the signal curves (AUC), root mean square (RMS) of all the harmonics, lower order (LO included 1st and 2nd order harmonic), higher order (HO up to 6th harmonic), CoST deformation amplitude (DA), corneal hysteresis (CH) and corneal resistance factor (CRF) were analyzed. Results: The device variables and those calculated by Fourier transform were statistically significantly different between CoST and ORA. These variables also differed between the eyes of the same subject. There was also statistically significant influence of eyes (left vs. right) on the differences in a sub-set of RMS variables only. CH and CRF differed statistically significantly between the eyes of subject (p<0.001) but not DA (p = 0.65). Conclusions: CoST was statistically significantly different from ORA. CoST may be useful in delineating true biomechanical differences between the eyes of a subject as it reports deformation. © 2014 Tejwani et al.


Salim S.,Glaucoma Service
Current Opinion in Ophthalmology | Year: 2014

PURPOSE OF REVIEW: Glaucoma management during pregnancy generates numerous therapeutic challenges and potential risks for both the patient and the fetus. Data are limited on this topic given the lack of large, prospective, and randomized clinical trials because of ethical and legal constraints in this patient population. Therefore, many ophthalmologists remain unsure about treating glaucoma during pregnancy and lactation. This review focuses on the importance of preconception planning, the natural course of intraocular pressure during pregnancy, and a discussion of various therapeutic modalities during pregnancy and lactation. RECENT FINDINGS: The risks of glaucoma medications during pregnancy are not well established for the human fetus or infant and are often inferred from animal studies. Some guidelines have been provided by the US Food and Drug Administration (FDA) about medication safety during pregnancy. Currently, brimonidine is classified as a category B medication with presumed safety based on animal studies. Other glaucoma medications (beta blockers, carbonic anhydrase inhibitors, parasympathomimetics, and prostaglandin analogues) are classified as category C medications with uncertain safety from the lack of human studies and reported adverse effects in animal studies. SUMMARY: The treatment of glaucoma during pregnancy and lactation requires careful consideration and understanding of disease status, stage of pregnancy, FDA classification and guidelines, and potential benefits and limitations of various therapeutic modalities. A multidisciplinary team approach is necessary to appropriately balance the risks and benefits of any intervention and to individualize treatment to achieve the best outcomes for both mother and fetus. © 2014 Wolters Kluwer Health.


Kim S.H.,Seoul National University | Kang J.H.,Kyung Hee University | Park K.H.,Seoul National University | Hong C.,Glaucoma Service
Japanese Journal of Ophthalmology | Year: 2012

Purpose: To compare Hong's grading method with anterior segment optical coherence tomography (AS-OCT), gonioscopy, and the dark-room prone-position test (DRPT) for evaluating anterior chamber width. Methods: The anterior chamber angle was graded using Hong's grading method, and Hong's angle width was calculated from the arctangent of Hong's grades. The correlation between Hong's angle width and AS-OCT parameters was analyzed. The area under the receiver operating characteristic curve (AUC) for Hong's grading method when discriminating between narrow and open angles as determined by gonioscopy was calculated. Correlation analysis was performed between Hong's angle width and intraocular pressure (IOP) changes determined by DRPT. Results: A total of 60 subjects were enrolled. Of these subjects, 53.5 % had a narrow angle. Hong's angle width correlated significantly with the AS-OCT parameters (r = 0.562-0.719, P<0.01). A Bland-Altman plot showed relatively good agreement between Hong's angle width and the angle width obtained by AS-OCT. The ability of Hong's grading method to discriminate between open and narrow angles was good (AUC = 0.868, 95 % CI 0.756-0.942). A significant linear correlation was found between Hong's angle width and IOP change determined by DRPT (r = -0.761, P<0.01). Conclusions: Hong's grading method is useful for detecting narrow angles. Hong's grading correlated well with AS-OCT parameters and DRPT. © Japanese Ophthalmological Society 2012.


PubMed | Repair and Regeneration in Ocular Workstation GROW research Laboratory, Cataract Surgery, Glaucoma Service, Refractive Surgery and Biomechanics and Mathematical Modeling Solutions IBMS Laboratory
Type: Journal Article | Journal: PloS one | Year: 2014

In this study, spectral analysis of the deformation signal from Corvis-ST (CoST) and reflected light intensity from ocular response analyzer (ORA) was performed to evaluate biomechanical concordance with each other.The study was non-interventional, observational, cross-sectional and involved 188 eyes from 94 normal subjects. Three measurements were made on each eye with ORA and CoST each and then averaged for each device. The deformation signal from CoST and reflected light intensity (applanation) signal from ORA was compiled for all the eyes. The ORA signal was inverted about a line joining the two applanation peaks. All the signals were analyzed with Fourier series. The area under the signal curves (AUC), root mean square (RMS) of all the harmonics, lower order (LO included 1st and 2nd order harmonic), higher order (HO up to 6th harmonic), CoST deformation amplitude (DA), corneal hysteresis (CH) and corneal resistance factor (CRF) were analyzed.The device variables and those calculated by Fourier transform were statistically significantly different between CoST and ORA. These variables also differed between the eyes of the same subject. There was also statistically significant influence of eyes (left vs. right) on the differences in a sub-set of RMS variables only. CH and CRF differed statistically significantly between the eyes of subject (p<0.001) but not DA (p=0.65).CoST was statistically significantly different from ORA. CoST may be useful in delineating true biomechanical differences between the eyes of a subject as it reports deformation.


PubMed | Glaucoma Service
Type: Journal Article | Journal: Journal of glaucoma | Year: 2010

To determine the spectrum of CYP1B1 gene mutations in Brazilian patients with primary congenital glaucoma, and to correlate the presence of alterations in the CYP1B1 gene sequence with clinical aspects of the disease.Thirty nonrelated patients with primary congenital glaucoma were studied. Molecular analysis consisted of the codifying region sequencing (exons 2 and 3) and intron/exon boundaries.CYP1B1 gene mutations were present in 9 (30%) of the 30 patients. The structural changes in the CYP1B1 gene previously described in the literature and observed in our study were Q19X, P437L, A443G, g.4340delG, g.7901_79013delGAGTGCAGGCAGA, g.8182delG, and g.8214_8215delG. Three new mutations were observed: 4635delT, 4523delC, and L378Q, in addition to 3793TC, R48G, A119S, L432V, D449D, and N453S polymorphisms. Patients carrying CYP1B1 gene mutations needed more surgical procedures to control intraocular pressure, either when both eyes were evaluated (P=0.003) or when the worst eye of the patient was analyzed (P=0.011). In relation to the number of affected eyes, all patients with mutations (n=9/9) developed bilateral glaucoma, whereas 11/21 patients without mutations in the CYP1B1 gene had bilateral glaucoma (P=0.013).In this group of primary congenital glaucoma patients, a 30% mutation frequency in the CYP1B1 gene was observed. The presence of mutations was associated with a more severe form of the disease, requiring more surgeries for intraocular pressure control and with a higher rate of bilateral cases.


PubMed | Pathology Service, Glaucoma Service, Ophthalmology Service and Retina and Vitreous Service
Type: Journal Article | Journal: International journal of ophthalmology | Year: 2016

To determine whether different intravitreal doses of quinupristin/dalfopristin lead to electroretinographic or histological changes in the rabbit retina over one month period after injection.Eighteen New Zealand white rabbits were divided into three treatment groups (groups 1 to 3) and different intravitreal doses of quinupristin/dalfopristin were tested in each group. The right eye was injected with the drug and the left eye received intravitreal injection of 5% dextrose water and served as control eye. The doses delivered to each group were 0.1 mg/0.1 mL, 1 mg/0.1 mL and 10 mg/0.1 mL. Simultaneous, bilateral, dark-adapted electroretinography and clinical images of both eyes were obtained in all groups before injection (baseline) and after 7, 14, 21 and 28d, followed by enucleation for histological examination.Subjects in the group 1 showed no signs of toxicity in the electroretinogram when compared with groups 2 and 3 (Kruskall-Wallis test, P=0.000). By day 7, no electrical response to light stimuli was recorded in the treated eyes in groups 2 and 3, consistent with severe damage due to retinal toxicity. Light microscopy revealed no significant histopathological changes in the group 1, while rabbits in groups 2 and 3 had signs of granulomatous inflammation in most cases.Intravitreal 0.1 mg/0.1 mL doses of quinupristin/dalfopristin do not lead to electroretinographic or histological signs of retinal toxicity compared with 1 mg/0.1 mL and 10 mg/0.1 mL in this rabbit model.


PubMed | Glaucoma Service
Type: | Journal: Clinical ophthalmology (Auckland, N.Z.) | Year: 2012

The purpose of this study was to determine any difference in dynamic contour tonometry and ocular pulse amplitude in asymmetric glaucoma patients with the same applanation intraocular pressure.This is a prospective, observational study of 30 glaucoma patients and 11 controls from June 2007 to February 2008. Most of the glaucoma patients were on prostaglandin analog treatment.Mean applanation intraocular pressure in the control group was 14.28 mmHg for the right eye and 14.10 mmHg for the left eye (P > 0.05). Corneal thickness was 519.10 m for the right eye and 511.07 m for the left eye (P > 0.05). Mean dynamic contour tonometry intraocular pressure was 17.28 mmHg for the right eye and 17.25 mmHg for the left eye (P > 0.05). Mean ocular pulse amplitude was 2.80 mmHg for the right eye and 2.92 mmHg for the left eye (P > 0.05).No differences in ocular pulse amplitude were found between the two groups and between the worst and the best eye. In spite of there being no difference in ocular pulse amplitude, dynamic contour tonometry intraocular pressure was 2.44 mmHg higher in the worst eye than in the best eye in the glaucoma patients, even with the same applanation intraocular pressure. Further studies are needed to confirm if this difference is related to glaucoma progression or a worst prognosis and whether it can be considered to be a new risk factor.

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