Ana Maria Marcondes

Endoscopic study of the intranasal ostium in external dacryocystorhinostomy postoperative. Influence of saline solution and 5-fluorouracil

PURPOSE To study, through endoscopy, the postoperative structural changes of the intranasal ostium following external dacryocystorhinostomy and to evaluate the influence of saline solution and 5-fluorouracil. METHODS Fifty patients were distributed into the following groups: Group SS-dacryocystorhinostomy and an injection of saline solution during surgery (13 patients); Group 5--FU1-dacryocystorhinostomy and an injection of 5 fluorouracil during surgery (17 patients); Group C--dacryocystorhinostomy only (11 patients); Group 5--FU3-dacryocystorhinostomy and 3 injections, 1 during surgery and 1 on the third and fifth postsurgical days (9 patients). RESULTS Pair-wise group comparisons using the nonparametric Mann-Whitney test revealed that there was a significant reduction of the ostium area only in Group 5-FU1 vs. Group SS on the 60th postoperative day (P <.01); however, a comparative study among the 4 groups using the Kruskal-Wallis test showed no significant changes in the ostium area on the 60th postoperative day. The ostium area within groups at the 30th vs 60th postoperative day was significantly reduced for Group C (P < .05; Mann-Whitney test); no significant changes were found for the other groups. DISCUSSION These results suggest that the use of 5-fluorouracil in external dacryocystorhinostomy does not significantly influence the final size of the surgical fistula as determined 2 months postsurgery.

Discrimination between normal and glaucomatous eyes with scanning laser polarimetry and optic disc topography: A preliminary report

Purpose To test the ability of structural parameters (as measured by scanning laser polarimetry (SLP) software 1.0.12 and confocal scanning laser ophthalmoscopy (CSLO) to discriminate between normal and glaucomatous eyes. Methods A total of 112 patients with primary open-angle glaucoma and 88 normal individuals were enrolled in the study. All individuals underwent a thorough ophthalmic evaluation, a 24–2 full threshold Humphrey visual field, SLP with the GDx, and CSLO with the TOPSS. Patients with marked cataract or low vision were excluded from the study. Cut-off points were selected and receiver operator characteristic (ROC) curves were created for each individual CSLO and SLP parameter. Finally, multivariate discriminant formulas were developed in order to achieve a better sensitivity (Se)/specificity (Sp) ratio for the diagnosis of glaucoma, initially separately for each device, and then combining parameters from CSLO and SLP. Results The mean deviation for the glaucoma group was −10.63 ±7.58 dB. Multivariate discriminant formulas resulted in better sensitivity/specificity ratios than any individual parameter, either for CSLO (Se: 90%; Sp: 81%; accuracy: 86%) or SLP (Se: 87%; Sp: 86%; accuracy: 86%). The multivariate formula combining parameters from both devices resulted in an improvement in the ability to diagnose glaucoma. An area under the ROC curve of 0.97 was obtained, with a sensitivity of 93%, a specificity of 91 %, and an accuracy of 92%. Conclusions The combination of structural parameters derived from CSLO and SLP in a multivariate discriminant formula may enhance the ability to diagnose glaucoma. Further studies investigating a random population are needed in order to test the validity of this formula.

Central retinal vein prethrombosis as an initial manifestation of protein S deficiency.

CONTEXT Retinal vein thrombosis is most common in old people, and is often associated with systemic vascular disease. One of its rare systemic causes is protein S deficiency. CASE REPORT A case of a 21-year-old woman with retinal vein prethrombosis associated only with protein S deficiency is described. She presented with acutely reduced visual acuity and a central scotoma in her left eye. Warfarin therapy was initiated, and complete improvement in ophthalmoscopic findings was subsequently observed. This case illustrates that protein S deficiency is a factor that should be considered in cases of retinal vein occlusion, particularly in young patients.

Discrimination between normal and glaucomatous eyes with the Topographic Scanning System: a preliminary report.

BACKGROUND AND OBJECTIVE To evaluate the ability of the Topographic Scanning System (TopSS; Laser Diagnostic Technologies, San Diego, CA) to differentiate individuals with glaucoma from normal subjects. PATIENTS AND METHODS The subjects were divided into two groups: primary open-angle glaucoma and normal. All individuals underwent a complete ophthalmic evaluation, a 24-2 full threshold Humphrey visual field evaluation, and a TopSS examination. Cut-off points were selected, receiver operator characteristic (ROC) curves were created, and sensitivity and specificity were calculated for individual TopSS parameters and combinations of variables using multivariate analysis. RESULTS One hundred twelve patients with glaucoma and 88 normal individuals were enrolled in the study. The best TopSS individual parameters were: average disc diameter (sensitivity: 64%, specificity: 89%, area under ROC curve: 0.824), total disc area (sensitivity: 85%, specificity: 66%, area under ROC curve: 0.802), and cup area (sensitivity: 69%, specificity: 85%, area under ROC curve: 0.797). The multivariate analysis resulted in an area under the ROC curve of 0.91 (sensitivity: 90%, specificity: 81%). CONCLUSIONS This preliminary report suggests that the use of a multivariate discriminant formula may enhance the ability to differentiate individuals with glaucoma from normal subjects with the TopSS, with high sensitivity and specificity. Further studies investigating a random population are needed to test the validity of this formula.

Septo-optic dysplasia: case report

A triade clinica da displasia septo-optica (DSO) compreende a ausencia de septo pelucido, displasia congenita do nervo optico e multiplos defeitos endocrinos. Uma forma incompleta de DSO tem sido reconhecida com dois dos tres elementos. Os autores relatam um caso de displasia septo-optica na forma incompleta em um garoto de 9 anos com baixa visao e nistagmo presentes desde o nascimento. O exame oftalmoscopico revelou papila pequena com imagem em duplo contorno bilateralmente. Ressonância magnetica mostrou hipoplasia dos nervos opticos, quiasma e ausencia do septo pelucido.

Influência da aplicação intraoperatória de mitomicina C tópica episcleral na proliferação e diferenciação de células epiteliais córneo-conjuntivais de coelhos

Objective: To evaluate the influence of a three-minute application of 0.02% mitomycin C (MMC) on proliferation and differentiation of rabbit corneal epithelial cells. Methods: Topical MMC or 0.9% saline solution was applied to the episclera of the temporal limbal area of both eyes, maintaining intact epithelial tissue in one eye, and after partial corneal deepithelialization in the contralateral eye. The animals were arranged in groups A (20 eyes), B (16 eyes) and C (14 eyes) and sacrificed respectively on the 4th, 15th and 45th postoperative days. In order to stimulate cell proliferation, group C was submitted to central corneal deepithelialization three days before sacrifice. Cell differentiation markers (AE1, AE3 and AE5) were used for differentiation analysis and 5-bromo-2-deoxyuridine (BrdU) for detection of corneal epithelial cells proliferation. Results: There was no statistical difference in differentiation cells when drugs or surgical techniques were analyzed. Cell proliferation when using MMC or SF was statis-tically significant at central and temporal areas when applied after partial corneal deepithelialization in all groups. Conclusion: These results suggest that the three-minute episcleral application of 0.02% MMC does not affect epithelial cell differentiation; however, when MMC application occurs after corneal deepithelialization, it may affect cell proliferation.

Discriminação entre olhos normais e glaucomatosos mediante polarimetria de varredura a laser

PURPOSE: To test the ability of the scanning laser polarimetry to discriminate between normal and glaucomatous eyes. METHODS: One-hundred and twelve patients with primary open-angle glaucoma and 88 normal individuals were enrolled in the study. All individuals underwent a complete ophthalmic evaluation, a 24-2 full threshold Humphrey visual field and a GDx examination. Cutoff points were selected, ROC curves were created, and the sensitivity (Se) and specificity (Sp) were calculated for each individual GDx parameter. Finally, a multivariate logistic analysis was developed in order to achieve a better Se/Sp ratio for the diagnosis of glaucoma. RESULTS: The best GDx individual parameters were: the number (Se: 79.5%%, Sp: 81.8%, area under the ROC curve: 0.870), maximum modulation (Se: 83.0%, Sp: 76.1%, area under the ROC curve: 0.842) and ellipse modulation (Se: 65.2%, Sp: 88.6%). The multivariate logistic analysis resulted in an area under the ROC curve of 0.920 (Se: 85.7%, Sp: 90.9%). CONCLUSIONS: The combination of 2 or more parameters in a multivariate logistic analysis increases the ability of scanning laser polarimetry to discriminate between normal and glaucomatous eyes.

Correlação entre o topógrafo de disco óptico (TOPSS) e índices do campo visual

PURPOSE: To evaluate the correlation between the parameters derived from the topographic scanning system (TOPSS) and visual field indices. METHODS: One-hundred and twelve primary open-angle glaucoma patients and 88 normal controls were enrolled in the study. All individuals underwent a thorough ophthalmic examination, including visual field (Humphrey 24-2, Full Threshold mode), evaluating Mean Deviation (MD) and correct pattern standard deviation (CPSD) and TOPSS (average disc diameter, total disc area, cup area, cup shape, cup volume, average cup depth, average disc depth, neuroretinal rim (NRR) volume, NRR area, cup/disc area ratio, horizontal cup/disc ratio e vertical cup/disc ratio). The comparison between groups was done using the Mann-Whitney Test or the independent Students t test. The correlation between the visual field indices and TOPSS parameters was performed with the Spearmans correlation. RESULTS: The TOPSS parameters with better correlation were: cup area (MD: r= -0.538, p<0.001; CPSD: r= 0.512, p<0.001), vertical C/D ratio (MD: r= -0.506, p<0.001; CPSD: r= 0.483, p<0.001) e cup/disc area ratio (MD: r= -0.458, p<0.001; CPSD: r= 0.453, p<0.001). However, there was considerable variability between groups with different levels of visual field loss. CONCLUSIONS: The TOPSS variables presented, in general, substantial correlation with visual field indices. Although some of these parameters showed highly significant correlations, considerable variability of the structural parameters for the same level of functional damage may limit the usefulness of TOPSS isolated parameters in the diagnosis of glaucoma.

Estudo da circulação retrobulbar e do campo visual após dose única oral de citrato de sildenafil (Viagra

Purpose: To analyze the effects of 100 mg of sildenafil citrate (Viagra®) on the retrobulbar circulation and visual field. Methods: A double masked, placebo controlled study was conducted in 10 males with a mean age of 27.7 + 5.68 years. The right eye of each volunteer underwent orbital color Doppler imaging and automated perimetry (Humphrey, program 30-2, Full-Threshold Strategy) at 3 occasions: baseline, 1 hour after placebo and 1 hour after 100 mg of sildenafil. The foveal threshold and the mean deviation (MD) were analyzed by automated perimetry on the three occasions. Color Doppler imaging allowed the measurement of the peak systolic velocity (PSV), end diastolic velocity (EDV) and Pourcelot index (PI) in the central retinal artery and ophthalmic artery. Results: The foveal threshold and the mean deviation did not show a significant change following the administration of sildenafil. The ophthalmic artery peak systolic velocity and end diastolic velocity significantly increased after the administration of sildenafil (p<0.001). The hemodynamic parameters in the central retinal artery and the ophthalmic artery PI did not significantly change. Conclusions: Sildefanil citrate increased the blood flow velocities in the ophthalmic artery in normal subjects, with no significant changes in the foveal threshold and mean deviation in the automated perimetry.