Bruno Campelo Leal

Comparison of retinal nerve fibre layer measurements using optical coherence tomography versions 1 and 3 in eyes with band atrophy of the optic nerve and normal controls

AimsTo compare retinal nerve fibre layer (RNFL) measurements were carried out with two different versions of an optical coherence tomography device in patients with band atrophy (BA) of the optic nerve and in normal controls.MethodsThe RNFL of 36 eyes (18 with BA and 18 normals) was measured using an earlier version of an optical coherence tomography device (OCT-1). The measurements were repeated using a later version of the same equipment (OCT-3), and the two sets of measurements were compared.ResultsUsing OCT-1, the peripapillary RNFL thickness (mean±SD, in μm) in eyes with BA measured 80.42±6.94, 99.81±14.00, 61.69±13.02, 101.70±12.54, and 57.36±16.52 corresponding to the total RNFL average, superior, temporal, inferior, and nasal quadrants, respectively. Using OCT-3, the corresponding measurements were 63.11±6.76, 81.22±13.34, 39.50±8.27, 86.72±15.16, and 45.05±8.03. Each of these measurements was significantly smaller with OCT-3 than with OCT-1. In normal eyes, RNFL average and temporal quadrant OCT-3 values were significantly smaller than OCT-1 values, but there was no significant difference in measurements from the superior, inferior, and nasal quadrant.ConclusionsRNFL measurements were smaller with OCT-3 than with OCT-1 for almost all parameters in eyes with BA and in the global average and temporal quadrant measurements in normal eyes. Investigators should be aware of this fact when comparing old RNFL measurement with values obtained with later versions of the equipment.

Retinal nerve fiber layer loss documented by Stratus OCT TM in patients with pituitary adenoma: case report

OBJETIVO: Relatar alteracoes na camada de fibras nervosas retiniana (CFNR) com o uso da tomografia de coerencia optica (Stratus OCTTM) em pacientes com adenoma hipofisario. METODOS: Dois pacientes com defeito perimetrico bitemporal de longa duracao e atrofia em banda do nervo optico foram examinados com tomografia de coerencia optica (Stratus OCTTM). RESULTADOS: Ambos pacientes demonstraram perda difusa da camada de fibras nervosas retiniana com reducao acentuada nas regioes nasal e temporal do disco optico. A perda da camada de fibras nervosas retiniana se correlacionou com o defeito de campo visual e com os estudos histologicos de atrofia em banda do nervo optico. CONCLUSOES: A tomografia de coerencia optica (Stratus OCTTM) pode apresentar grande utilidade no diagnostico da atrofia em banda decorrente de lesoes quiasmaticas tais como os adenomas pituitarios.

Comparação entre o polarímetro de varredura a laser, a tomografia de coerência óptica 1 e o Stratus-oct na detecção da perda axonal da atrofia em banda do nervo óptico

OBJETIVO: Comparar a capacidade do polarimetro de varredura a laser (GDx), do tomografo de coerencia optica (OCT) 1 e do Stratus-OCT em diferenciar olhos normais de olhos com atrofia em banda do nervo optico e hemianopsia temporal. METODOS: Vinte e tres olhos de pacientes com atrofia em banda do nervo optico e 23 olhos de individuos normais foram incluidos em estudo prospectivo observacional caso-controle. Todos foram submetidos a analise da camada de fibras nervosas retiniana (CFNR) utilizando GDx, OCT-1 e Stratus-OCT. As medias dos valores obtidos em cada aparelho foram comparadas entre olhos com atrofia em banda e controles normais. Curvas ROC (receiver operating characteristic) e sensibilidade para especificidades fixas (80% e 95%) foram calculadas para cada parâmetro produzido pelos tres instrumentos e comparadas entre si. RESULTADOS: Quando comparados aos individuos normais, os resultados dos pacientes referentes a camada de fibras nervosas retiniana (media global e quatro quadrantes estudados) foram significativamente menores (p<0,05) em todos os aparelhos estudados, com excecao do parâmetro referente ao setor temporal quando avaliado pelo GDx. A comparacao das areas sob a curva ROC (AROC) dos parâmetros referentes aos tres aparelhos mostrou valores significativamente maiores para o Stratus-OCT quando comparados ao OCT-1 na media global e no setor temporal. O Stratus-OCT foi significativamente mais sensivel do que o GDx na media global e nos quadrantes temporal, nasal e inferior. Por sua vez, o OCT-1 foi superior ao GDx na discriminacao dos defeitos apenas no quadrante temporal, nao mostrando diferenca significativa na media global e nos demais quadrantes. Os tres aparelhos mostraram capacidade semelhante na identificacao dos defeitos referentes ao quadrante superior. CONCLUSAO: O Stratus-OCT demonstrou a maior capacidade em diferenciar olhos com atrofia em banda do nervo optico de olhos normais embora todos os tres aparelhos consigam identificar a maioria dos olhos anormais. O OCT-1 se mostrou inferior ao Stratus-OCT e superior ao GDx no quadrante temporal. Embora o GDx tenha sido capaz de identificar algum tipo de alteracao na maioria dos olhos estudados, este aparelho se mostrou pouco sensivel na deteccao da perda axonal nos quadrantes nasal e temporal do disco optico, devendo ser utilizado com cuidado no estudo de afeccoes neuroftalmologicas que acometem estas regioes do disco optico.

Steroid‐induced ocular hypertensive response in children and adolescents with acute lymphoblastic leukemia and non‐hodgkin lymphoma

The aim of this study was to evaluate intraocular pressure (IOP) associated with use of glucocorticoids in children and adolescents treated for acute lymphoblastic leukemia and non‐Hodgkin lymphoma. We carried out a prospective descriptive study with measurement of IOP before treatment (D0), 8th (D8), 14th (D14), and 28h days (D28) of treatment. We examined 12 patients, with two cases of ocular hypertension, and it was found a statistically significant difference between the means of IOP between D0 versus D8 and D0 versus D14 (P = 0.013). The possibility of silent ocular hypertension with irreversible blindness indicates the need of IOP verification. Pediatr Blood Cancer 2014;61:2083–2085.

Alterações retinianas em jovens portadores de anemia falciforme (hemoglobinopatias) em hospital universitário no nordeste do Brasil

PURPOSES To describe and categorize retinal vascular changes in patients with sickle cell anemia, as well as to compare diagnostic methods (indirect ophthalmoscopy and fluorescein angiography). METHODS Patients with sickle cell anemia over the age of seven were examined. Complete ophthalmologic examination with indirect ophthalmoscopy and angiography was performed in each patient. The fundoscopy results were grouped in 3 classes: normal; non-proliferative retinopathy, which includes vascular tortuosity, black sunburst, salmon-patch and peripheral closure/anastomoses; and proliferative retinopathy, related to neovascular proliferation. Angiography results were classified according to Goldberg classifications from stage I to V. RESULTS Retinopathy related to sickle cell anemia was seen in 62.3% (38/61) of the eyes checked. Neovascularization was observed in one eye. The frequency of bilateral changes in angiography was high. Non-proliferative retinopathy was more common, especially vascular tortuosities (17/61), followed by arteriovenous anastomoses in the retinal periphery (15/61) and arterial occlusions (5/61). The mean age of retinopathy group was 14.4 years old, significantly lower than the mean age of non-retinopathy group, which was 17.4. The result was normal in 16.4% (10/61) of the eyes in the fundoscopy exam, while angiography showed alterations. CONCLUSIONS All the results pointed to the conclusion that the non-proliferative retinal vascular changes are frequent and precocious in patients with sickle cell anemia (SS genotype). Fluorescein angiography is more sensitive in the diagnosis of retinopathy when compared to indirect ophthalmoscopy.

Nerve fiber analyzer: a study on the false-positive results

Purpose: To determine the fiber layer analyzer GDxs specificity in a group of normal subjects, and the most altered parameters for this group. Methods: Normal patients were examined (complete ophthalmologic examination) and then we performed the fiber layer analysis with NFA- GDx (LDT). Total: 34 randomly selected eyes. Results and Conclusion: The specificity was 58.8%, and the corrected specificity 70.5%. The most altered parameter was symmetry (85.71%), and the less altered, the inferior and superior ratio (0%). When we have an isolated altered symmetry in a patient with normal IOP and normal optic disc, the false-positive diagnosis must be remembered; when a suspected glaucoma patient has an altered inferior ratio, glaucoma diagnosis must be remembered.