Análise da espessura da coroide na gestação utilizando tomografia de coerência óptica de domínio espectral

Objetivo: Avaliar a espessura da coroide no terceiro trimestre de gestação em pacientes sem comorbidades, com pré-eclâmpsia (PE) e com diabetes melito (DM) utilizando tomografia de coerência óptica de domínio espectral (SD-OCT). Métodos: Estudo transversal que incluiu 306 olhos de 153 mulheres divididas em 6 grupos: 34 mulheres não grávidas saudáveis, 27 gestantes saudáveis, 47 gestantes com PE e 45 gestantes com DM, sendo 15 com diabetes melito gestacional (DMG), 16 com DM tipo 2 (DM2) e 14 com DM tipo 1 (DM1). Todas as gestantes estavam no terceiro trimestre de gestação. As medidas de espessura da coroide foram realizadas utilizando SD-OCT em 10 localizações: subfoveal e a cada 500μm até 2000μm nasal à fovea e 2500μm temporal à fóvea. Resultados: Não houve diferença nas medidas de espessura da coroide entre o grupo de mulheres não grávidas e o grupo de gestantes saudáveis. Ao comparar a espessura da coroide entre gestantes saudáveis e gestantes com DMG, DM2, DM1, pacientes com DM1 apresentaram coroides mais finas em todas as localizações, com significância estatística nas medidas subfoveal e temporais. Gestantes com DMG e DM2 não apresentaram diferença nas medidas de espessura da coroide em comparação com gestantes saudáveis. Ao comparar o grupo de gestantes saudáveis com o grupo de gestantes com PE, as medidas de espessura da coroide foram maiores no grupo de gestantes com PE, com significância estatística nas medidas nasais. Ao dividir as gestantes com PE conforme critérios de gravidade, pacientes com PE grave apresentaram uma tendência a terem coroides mais espessas em comparação com pacientes com PE leve e gestantes saudáveis. Pacientes com PE e descolamento seroso de retina (SRD) apresentaram coroides significativamente mais espessas em todas as localizações em comparação com pacientes com PE sem SRD. Conclusões: Por ser um exame rápido, seguro e não invasivo, a OCT é ideal para a análise da coroide durante o período gestacional. A gestação sem x intercorrências não modificou a espessura da coroide em pacientes no terceiro trimestre, em comparação com mulheres não grávidas. Gestantes com DM1, por outro lado, apresentaram coroides mais finas em comparação com gestantes saudáveis, provavelmente pelas alterações decorrentes da coroidopatia diabética. Gestantes com PE apresentaram coroides mais espessas em comparação com gestantes saudáveis, com significância estatística nas medidas nasais. Já pacientes com SRD apresentaram coroides marcadamente mais espessas em todas as localizações. Podemos concluir, a partir destes achados, que a PE cursa com um espessamento da coróide, que se inicia na região peripapilar. Com a progressão do desbalanço, toda a coróide torna-se espessada.Objective: To analyze choroidal thickness of healthy pregnant women and pregnant women with preeclampsia (PE) and diabetes mellitus (DM) in the third trimester using spectral domain optical coherence tomography (SD-OCT). Methods: This cross-sectional study included 306 eyes of 153 women divided into 6 groups: 34 healthy non-pregnant women, 27 healthy pregnant women, 47 pregnant women with PE and 45 pregnant women with DM, 15 of them with gestational diabetes mellitus (GDM), 16 with type 2 DM and 14 with type 1 DM. All pregnant women were in the third trimester of pregnancy. Choroidal thickness was measured using SD-OCT at ten different locations: at the fovea and every 500μm from the fovea up to 2500μm temporally and up to 2000μm nasally. Results: There were no significant differences in choroidal thickness between healthy non-pregnant women and healthy pregnant women in the third trimester. Choroid tended to be thicker in subjects with preeclampsia in comparison with healthy pregnant women, with statistical significance in nasal measures. Dividing PE group accordingly disease severity, women with severe preeclampsia tended to have thicker choroids in comparison with mild preeclamptic and healthy pregnant women. Choroid was also significantly thicker in preeclamptic patients with serous retinal detachment (SRD) in comparison with preeclamptic patients without SRD. The choroidal thickness comparison between healthy pregnant women and pregnant women with GDM, type 2 DM and type 1 DM showed a thinner choroid in patients with type 1 DM in all locations, with statistical significance in subfoveal and temporal measurements. No differences were found in choroidal thickness between healthy pregnant women and pregnant women with GDM and type 2 DM. Conclusions: EDI-OCT is a fast, noninvasive and safe method for choroid analysis during pregnancy. Pregnancy did not change choroidal thickness in third trimester patients compared to nonpregnant women. Pregnant women with type 1 DM had significantly thinner choroidal thickness measurements on subfoveal xii and temporal locations, probably due to diabetic choroidopathy modifications. Choroid tends to be thicker in patients with preeclampsia, with statistical significance only in nasal measures. In patients with SRD, however, choroid is markedly thicker at all points analyzed. From these findings we can hypothesize that preeclampsia can cause a choroidal thickening, which begins in the peripapillary area. As the imbalance increases, the entire choroid becomes thickened

Changes in choroidal thickness and volume are related to urinary albumin excretion in type 2 diabetic patients without retinopathy

Purpose: To evaluate choroidal thickness and volume in patients with type 2 diabetes and microalbuminuria using spectral-domain optical coherence tomography. Methods: We recruited 37 diabetic patients without diabetic retinopathy (18 normoalbuminuric and 19 microalbuminuric) and 21 healthy controls. Choroidal thickness and volume were mapped using the automated Early Treatment Diabetic Retinopathy Study grid and a topographic map of thickness was generated manually. Choroid was also measured at 10 locations under the fovea, temporally and nasally. Results: Mean choroidal thickness and volume among patients with diabetes and microalbuminuria was reduced in all locations compared to controls (P,0.05). A sectoral decrease of choroidal thickness and volume was shown between microalbuminuric and normoalbuminuric groups. Conclusion: Choroidal changes were present in type 2 diabetic patients before clinical development of retinopathy. Microalbuminuria was associated with a decrease in choroidal thickness and volume in diabetic patients without diabetic retinopathy

Individual macular layer evaluation with spectral domain optical coherence tomography in normal and glaucomatous eyes

Purpose: To evaluate differences in the thickness of the individual macular layers between early, moderate, and severe glaucomatous eyes and compare them with healthy controls. Patients and Methods: Subjects with glaucoma presenting typical optic nerve head findings, high intraocular pressure with or without visual field (VF) damage and normal controls were included. All participants underwent 24–2 perimetry and spectral-domain OCT. Patients were divided into three groups (early, moderate, and severe) based on the mean deviation of the VF and a healthy control group. The device segmented the layers automatically, and their measurements were plotted using the means of the sectors of the inner (3mm) and outer (6mm) circles of the ETDRS grid. Results: A total of 109 eyes qualified for the study: 14 in the control group and 52, 18 and 25 in the early, moderate and severe groups, respectively. Mean age was 66.13 (SD=12.38). The mean thickness of the circumpapillary retinal nerve fiber layer (RNFL), total macular thickness (TMT), macular RNFL, ganglion cell layer (GCL) and inner plexiform layer (IPL) were significantly different between the 4 groups, with progressive decrease in thickness. Significant overall difference was found for the inner nuclear layer (INL), and the severe glaucoma group presented thicker measurements than controls and early glaucoma. Outer nuclear layer (ONL) was thinner in severe glaucoma group compared with early glaucoma group. Conclusion: Individual macular layer measurement using the inner and outer circles of the ETDRS grid is useful to evaluate different stages of glaucoma. The INL thickening and ONL thinning in advanced glaucoma should be explored in the future studies

Influência do estradiol sobre o controle reflexo da pressão arterial e no equilíbrio entre as atividades da NADPH oxidase e no sintase

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Análise da espessura da coroide na gestação utilizando tomografia de coerência óptica de domínio espectral

Objetivo: Avaliar a espessura da coroide no terceiro trimestre de gestação em pacientes sem comorbidades, com pré-eclâmpsia (PE) e com diabetes melito (DM) utilizando tomografia de coerência óptica de domínio espectral (SD-OCT). Métodos: Estudo transversal que incluiu 306 olhos de 153 mulheres divididas em 6 grupos: 34 mulheres não grávidas saudáveis, 27 gestantes saudáveis, 47 gestantes com PE e 45 gestantes com DM, sendo 15 com diabetes melito gestacional (DMG), 16 com DM tipo 2 (DM2) e 14 com DM tipo 1 (DM1). Todas as gestantes estavam no terceiro trimestre de gestação. As medidas de espessura da coroide foram realizadas utilizando SD-OCT em 10 localizações: subfoveal e a cada 500μm até 2000μm nasal à fovea e 2500μm temporal à fóvea. Resultados: Não houve diferença nas medidas de espessura da coroide entre o grupo de mulheres não grávidas e o grupo de gestantes saudáveis. Ao comparar a espessura da coroide entre gestantes saudáveis e gestantes com DMG, DM2, DM1, pacientes com DM1 apresentaram coroides mais finas em todas as localizações, com significância estatística nas medidas subfoveal e temporais. Gestantes com DMG e DM2 não apresentaram diferença nas medidas de espessura da coroide em comparação com gestantes saudáveis. Ao comparar o grupo de gestantes saudáveis com o grupo de gestantes com PE, as medidas de espessura da coroide foram maiores no grupo de gestantes com PE, com significância estatística nas medidas nasais. Ao dividir as gestantes com PE conforme critérios de gravidade, pacientes com PE grave apresentaram uma tendência a terem coroides mais espessas em comparação com pacientes com PE leve e gestantes saudáveis. Pacientes com PE e descolamento seroso de retina (SRD) apresentaram coroides significativamente mais espessas em todas as localizações em comparação com pacientes com PE sem SRD. Conclusões: Por ser um exame rápido, seguro e não invasivo, a OCT é ideal para a análise da coroide durante o período gestacional. A gestação sem x intercorrências não modificou a espessura da coroide em pacientes no terceiro trimestre, em comparação com mulheres não grávidas. Gestantes com DM1, por outro lado, apresentaram coroides mais finas em comparação com gestantes saudáveis, provavelmente pelas alterações decorrentes da coroidopatia diabética. Gestantes com PE apresentaram coroides mais espessas em comparação com gestantes saudáveis, com significância estatística nas medidas nasais. Já pacientes com SRD apresentaram coroides marcadamente mais espessas em todas as localizações. Podemos concluir, a partir destes achados, que a PE cursa com um espessamento da coróide, que se inicia na região peripapilar. Com a progressão do desbalanço, toda a coróide torna-se espessada.Objective: To analyze choroidal thickness of healthy pregnant women and pregnant women with preeclampsia (PE) and diabetes mellitus (DM) in the third trimester using spectral domain optical coherence tomography (SD-OCT). Methods: This cross-sectional study included 306 eyes of 153 women divided into 6 groups: 34 healthy non-pregnant women, 27 healthy pregnant women, 47 pregnant women with PE and 45 pregnant women with DM, 15 of them with gestational diabetes mellitus (GDM), 16 with type 2 DM and 14 with type 1 DM. All pregnant women were in the third trimester of pregnancy. Choroidal thickness was measured using SD-OCT at ten different locations: at the fovea and every 500μm from the fovea up to 2500μm temporally and up to 2000μm nasally. Results: There were no significant differences in choroidal thickness between healthy non-pregnant women and healthy pregnant women in the third trimester. Choroid tended to be thicker in subjects with preeclampsia in comparison with healthy pregnant women, with statistical significance in nasal measures. Dividing PE group accordingly disease severity, women with severe preeclampsia tended to have thicker choroids in comparison with mild preeclamptic and healthy pregnant women. Choroid was also significantly thicker in preeclamptic patients with serous retinal detachment (SRD) in comparison with preeclamptic patients without SRD. The choroidal thickness comparison between healthy pregnant women and pregnant women with GDM, type 2 DM and type 1 DM showed a thinner choroid in patients with type 1 DM in all locations, with statistical significance in subfoveal and temporal measurements. No differences were found in choroidal thickness between healthy pregnant women and pregnant women with GDM and type 2 DM. Conclusions: EDI-OCT is a fast, noninvasive and safe method for choroid analysis during pregnancy. Pregnancy did not change choroidal thickness in third trimester patients compared to nonpregnant women. Pregnant women with type 1 DM had significantly thinner choroidal thickness measurements on subfoveal xii and temporal locations, probably due to diabetic choroidopathy modifications. Choroid tends to be thicker in patients with preeclampsia, with statistical significance only in nasal measures. In patients with SRD, however, choroid is markedly thicker at all points analyzed. From these findings we can hypothesize that preeclampsia can cause a choroidal thickening, which begins in the peripapillary area. As the imbalance increases, the entire choroid becomes thickened