Geraldo Vicente de Almeida

Modified Schocket implant for refractory glaucoma. Experience of 55 cases.

Fifty-five eyes of 51 patients with different forms of refractory glaucoma (15 aphakic, 12 neovascular, 9 postpenetrating keratoplasty, 8 congenital, 5 secondary to uveitis, 4 associated with aniridia, 1 pseudophakic, and 1 traumatic) underwent antiglaucomatous surgery using a modified 90 degrees Schocket implant. In 25 eyes (45.4%), this was the first surgical procedure. Follow-up ranged from 3 to 27 months (mean, 10.3 +/- 5.4 months). The mean preoperative intraocular pressure (IOP) was 39.5 +/- 8.6 mmHg (range, 22 to 66 mmHg). The mean postoperative IOP was 17.8 +/- 7.6 mmHg (range, 4 to 50 mmHg). Intraocular pressure remained less than 21 mmHg in 50 eyes (90.9%) during the follow-up period. In 13 of these eyes (26.0%), IOP remained under control without any medication. Complications were observed in 13 eyes (23.6%) and were successfully treated in 11 of them. Complications included iris-tube block (5.4%), vitreous-tube block (3.6%), early postoperative flat anterior chamber (1.8%), choroidal effusion (3.6%), tube exteriorization from anterior chamber (3.6%), tube displacement from silicone band (1.8%), retinal detachment (1.8%), tube-cornea touch (1.8%), vitreous hemorrhage (1.8%), infectious endophthalmitis (1.8%), and phthisis bulbi (1.8%). Modified 90 degrees Schocket implants are an effective technique in the management of refractory glaucoma.

Lack of association between optineurin gene variants T34T, E50K, M98K, 691_692insAG and R545Q and primary open angle glaucoma in Brazilian patients.

Purpose: To verify the frequencies of T34T, E50K, M98K, 691_692insAG, and R545Q variants in the optineurin (OPTN) gene in Brazilian subjects with primary open-angle glaucoma (POAG) and controls. Patients and Methods: Ninety-nine patients with POAG and 100 normal controls were enrolled in this study. The frequency of alterations in the OPTN gene was analyzed by direct sequencing and enzymatic digestion of PCR products. Results: None of the five alterations evaluated was significantly associated with POAG when compared to controls. However, the T34T silent change was present in greater frequency in POAG patients (37.37% vs. 23.00% in controls), while the R545Q change was more prevalent in controls (23.00% vs. 10.10% in POAG). The M98K and 691_692insAG presented with low frequencies in POAG patients (1.01% and 2.02%, respectively) and controls (2.00% and 2.00%, respectively). The E50K substitution was not observed. Conclusion: Our data show no association between the five evaluated variants and POAG in the Brazilian population.

Quality of Life in Patients with Glaucoma Who Live in a Developing Country

Purpose: To assess the functional status and well-being in glaucoma patients who live in a developing country. Methods: Cross-sectional case control study, comprising 102 glaucoma patients and 58 controls. All subjects were administered the Medical Outcomes Study 36-item short-form survey (SF-36). SF-36 scores for study and control groups were compared. Statistical analysis included Student’s t-test for score data and Student’s t- and chi-square tests for demographic data. Results: Patients with glaucoma had significantly lower scores than healthy control subjects (p < 0.05) in five domains of the SF-36 survey (physical functioning, role-emotional, bodily pain, social functioning and mental health). Bodily pain was the domain with the lowest score. Conclusions: Patients with glaucoma who live in a developing country have less functional status than non-glaucomatous patients.

Localização e freqüência das alterações de campo visual no glaucoma primário de ângulo aberto na estratégia SITA (Swedish Interactive Threshold Algorithm)

PURPOSE To evaluate the frequency, location and pattern of visual field defects as measured by SITA strategy in primary open angle glaucoma (POAG). METHODS Six thousand and two-hundred charts were reviewed. One hundred and fifty two patients who fulfilled the inclusion criteria were included. They were stratified according to severity into early, moderate and severe. The following visual field defects were defined: nasal step, paracentral scotomata, arcuate defect, Seidel scotomata, temporal defect, general reduction of sensitivity, annular scotomata and central island. Each examination was divided into sectors corresponding to optic disc regions. Students t test was used to compare differences in frequency. RESULTS In the early glaucoma group, the nasal superior step was the most frequent visual field defect, followed by paracentral scotoma and inferior nasal step. General reduction of sensitivity was noted in 7.8%. Defects were more common in the superior hemifield (p<0.05). CONCLUSION The superior nasal step and paracentral scotoma were the most commun visual field defects in early primary open angle glaucoma as evaluated by SITA strategy, and the superior hemifield comprises most of the defects. General reduction of sensitivity was an early and rare visual field defect.

Sensibilidade do estímulo de tamanho I na perimetria computadorizada acromática para a detecção de defeitos glaucomatosos no campo visual: análise comparativa com as perimetrias de ondas curtas e acromática convencional (SITA)

PURPOSE To compare sensitivity and specificity of achromatic perimetry with size I stimulus (WW-I) with standard automated perimetry (SITA strategy) and blue on yellow perimetry (SWAP) for early diagnosis of glaucoma. METHODS Seventy-three eyes of 73 suspects, glaucomatous and normal subjects underwent automated perimetry with SITA 24-2, WW-I and SWAP. After application of specific criteria of abnormality, sensitivity, specificity, and the area under ROC (Receiver Operating Characteristic) curve were calculated for each of the examinations. The areas under the ROC curve were compared pair-wisely with the univariable Z test and significance set at 5%. RESULTS WW-I displayed the greatest sensitivity (100%) and the lowest specificity (75.7%). SWAP revealed less sensitivity (69.4%); specificity, however, was higher (89.2%). Pairwise comparison of ROC curves showed no difference. CONCLUSION WW-I revealed good sensitivity for the detection of early glaucomatous visual field defects. This technique adds to the available armamentarium for early functional diagnosis of glaucomatous optic neuropathy.

Variação da acuidade visual em pacientes jovens com ectopia lentis submetidos à cirurgia

PURPOSE To assess the results as to visual acuity of two different surgical procedures for ectopia lentis. METHODS Fifty-one eyes of 28 patients (16 males and 12 females, mean age 16.00 +/- 8.5) with simple (19 cases) or Marfan syndrome-associated (9 cases) ectopia lentis with different levels of subluxation underwent lens extraction with implantation of intraocular lenses (IOL) with scleral fixation (21 cases) or by lens extraction with implantation of the intraocular lenses in the capsular bag expanded by endocapsular ring (RING) (30 cases). Result analysis emphasized pre- and postoperative visual acuity during a six-month follow-up. RESULTS Both techniques showed significant increase of postoperative visual acuity with and without correction, but it was better among the cases operated on by scleral fixation of the intraocular lenses. More than the used technique, the preoperative subluxation grades were crucial as to the results. CONCLUSION The two surgical techniques for correction of simple or Marfan syndrome-associated ectopia lentis are safe and effective, resulting in significant recovery of visual acuity, although surgical results are completely dependent on the preoperative lens subluxation grades.

Comparação a longo prazo entre a facectomia extracapsular combinada à trabeculectomia e à facotrabeculectomia

Objetivo: Comparar os resultados a longo prazo entre a cirurgia extracapsular da catarata combinada a trabeculectomia (FEC/TREC) e a facotrabeculectomia (FACO/TREC). Metodos: Os prontuarios de 46 pacientes (53 olhos) submetidos a cirurgia combinada na Santa Casa de Sao Paulo entre janeiro de 1996 e novembro de 1999 foram revisados; dados relativos a pressao ocular (PO), acuidade visual (AV) e numero de medicacoes foram analisados. Resultados: Em ambos os grupos, apos seguimento medio de 18 meses, a acuidade visual melhorou e a pressao ocular diminuiu em relacao aos valores pre-operatorios (P<0,05); 55,5% no grupo da facotrabeculectomia e 46,1% no grupo da catarata combinada a trabeculectomia obtiveram a pressao ocular final menor que 22 mmHg sem medicacao (P=0,3). Conclusao: Ambas as tecnicas sao eficazes no tratamento simultâneo do glaucoma e da catarata. Entretanto, a facotrabeculectomia parece promover pressao ocular menor sem a necessidade do uso de medicacoes hipotensoras oculares em maior numero de pacientes.

Reliability of echographic examination for the study of optic nerve cupping

Purpose: To investigate the reliability and applicability of echography to detect optic nerve cupping smaller than or equal to 0.3 and greater than or equal to 0.9. Patients and Method: Fifty-three eyes from 30 patients, with transparent optic media, underwent contact B-scan echography to evaluate optic disc cupping. On biomicroscopy, twenty-six eyes presented small (Group 1) and 27 large (Group II) optic nerve cupping. Results: B-scan images of the optic disc were evaluated by two observers and ocular echography was considered reliable with a Kappa index of 0.77 (± 0.14). Sensitivity and specificity were 71.4 % (53.4 81.1) and 96.2 % (78.4 99.8), respectively, with a confidence interval of 95 % • The positive and negative predictive values found for the sample were 95.2 % (7 4.1 99.8) and 78.1 % (59.6 90.1), respectively. Conclusion: Echography is a reliable method to evaluate optic disc cupping when s; 0.3 and � 0.9. However, as a screening method it would be more important in the case of negative results.

Estudo comparativo entre Halotano e Isoflurano quanto à influência sobre a pressão intraocular

O estudo comparativo entre os efeitos dos anestesicos halotano e isoflurano sobre a pressao intraocular mostrou nao haver diferenca entre eles