Francisco Eduardo Lima

A prospective, comparative study between endoscopic cyclophotocoagulation and the Ahmed drainage implant in refractory glaucoma.

Purpose:To compare endoscopic cyclophotocoagulation (ECP) and the Ahmed drainage implant in the treatment of refractory glaucoma. Methods:Sixty-eight eyes of 68 patients with refractory glaucoma were prospectively assigned to either ECP or Ahmed tube shunt implantation. All procedures were performed by a single surgeon. Eyes that were included were pseudophakic with a history of at least one trabeculectomy with antimetabolite, an intraocular pressure (IOP) equal to or above 35 mm Hg on maximum tolerated medical therapy, and a visual acuity better than light perception. Exclusion criteria included eyes that had had previous glaucoma drainage device implantation or a cyclodestructive procedure. Success was defined as an IOP more than 6 mm Hg and less than 21 mm Hg, with or without topical anti-hypertensive therapy. Results:The mean follow-up was 19.82 ± 8.35 months and 21.29 ± 6.42 months, for the Ahmed and ECP groups, respectively (P = 0.4). The preoperative IOP, 41.32 ± 3.03 mm Hg (Ahmed) and 41.61 ± 3.42 mm Hg (ECP) (P = 0.5), and the mean postoperative IOP, at 24 months follow-up, 14.73 ± 6.44 mm Hg (Ahmed) and 14.07 ± 7.21 mm Hg (ECP) (P = 0.7), were significantly different from baseline in both groups (P < 0.001). Kaplan-Meier survival curve analysis showed a probability of success at 24 months of 70.59% and 73.53% for the Ahmed and ECP groups, respectively (P = 0.7). Complications included choroidal detachment (Ahmed 17.64%, ECP 2.94%), shallow anterior chamber (Ahmed 17.64%, ECP 0.0%), and hyphema (Ahmed 14.7%, ECP 17.64%). Conclusion:There was no difference in the success rate between the Ahmed Glaucoma Valve and ECP in refractory glaucoma. The eyes that underwent Ahmed tube shunt implantation had more complications than those treated with ECP.

Quality of life in glaucoma patients: Regression analysis and correlation with possible modifiers

PURPOSE To verify the quality of life in a Brazilian glaucoma population and the influence of possible modifiers (e.g., visual acuity, visual field impairment). METHODS Forty-five consecutive patients from CEROF - Federal University of Goiás, Brazil were included prospectively in the study. The quality of life was assessed using the Portuguese version of the VFQ. Possible modifiers were evaluated, initially separately with the Spearmans Correlation and then together in a regression model. RESULTS The mean age was 59.6 ± 12.4 years. The mean quality of life score was 79 ± 15 (range 45-100). Age (r = −0.402, p = 0.006), visual acuity in the better eye (r = −0.497, p = 0.001) and in the worse eye (r = −0.608, p < 0.001), Hodapp-Parrish-Anderson visual field grading scale in the better (r = −0.353, p = 0.01) and worse eye (r = −0.387, p = 0.009), visual field Mean Deviation (MD) in the better (r = 0.355, p = 0.01) and worse eye (r = 0.320, p = 0.04) and ability to perform a visual field test in both eyes (r = −0.397, p = 0.007) were significantly correlated with the quality of life scores. However, only age (younger, better quality of life, p = 0.008) and visual acuity in the better eye (direct relation, p = 0.04) were significant in the regression model (r = 0.633, r2 = 0.401). CONCLUSIONS The VFQ may be a useful tool to assess the quality of life in glaucoma patients. The preliminary results indicate that age and visual acuity in the better eye are the main factors related to the quality of life in these patients.

Ibopamine provocative test and glaucoma: Consideration of factors that may influence the examination

Purpose. To evaluate factors that may influence the ibopamine provocative test for the diagnosis of glaucoma. Methods. Two Ibopamine (3,4 di-isobutyrylester of N-methyldopamine) 2% eyedrops were instilled 5 minutes apart in one eye selected at random in both glaucoma and normal subjects. The intraocular pressure (IOP) was assessed prior to the drops and 30, 60 and 180 minutes after instillation. The test was considered positive when there was an IOP increase of greater than 4 mmHg at any one of the timepoints. The amount of IOP change was compared to the severity of glaucomatous visual field loss and to the types of medical treatment. Results. The sensitivity (glaucoma patients with a positive result) and specificity (normal individuals with a negative result) of the Ibopamine test was 87 and 95%, respectively. Glaucoma patients using prostaglandin analogues did not have a significant IOP elevation. Conclusion. The Ibopamine provocative test may be an auxiliary test in glaucoma diagnosis. Concurrent use of prostaglandin analogues reduces the test’s sensitivity.

Melhora dos limiares de sensibilidade do campo visual após redução da pressão intra-ocular em pacientes com glaucoma: tratamento cirúrgico vs. clínico

PURPOSE To verify the influence of modality of treatment in regions of the glaucomatous visual field after reduction of intraocular pressure (IOP). METHODS Glaucoma patients that had undergone a reduction of IOP of at least 20% in a period of 2 months were retrospectively selected and divided into 2 groups: 1) after trabeculectomy; 2) after clinical treatment. Visual field global indices and thresholds (average, divided according to the severity based on the Pattern Deviation plot) were compared before and after IOP reduction. RESULTS Thirty-one eyes of 22 patients were selected (15 in group 1, and 16 in group 2). Both groups showed good ability regarding improvement of different regions of the visual field after IOP reduction. Only the percentage of reduction of IOP (52.3+/-18.9% and 37.8+/-15.2% for groups 1 and 2, respectively, p=0.02) and the percentage of improvement in the points damaged at p<0.5% (186.0+/-213.3% and 30.1+/-35.2% for groups 1 and 2, respectively, p=0.02) were different, but not statistically significant after alpha error correction between groups. CONCLUSION The reduction of IOP above 20% may be associated with improvement in regions of the glaucomatous visual field, regardless of treatment modality.