Flutuação da pressão intraocular em olhos saudáveis e olhos glaucomatosos: análise comparativa entre a curva tensional diária simplificada nas posições sentada, supina e o teste de sobrecarga hídrica

Purpose: To compare intraocular pressure (IOP) using the simplified daily tensional curve (SDTC) between supine and sitting positions in terms of peak levels and amount of fluctuation in both, glaucomatous and healthy subjects. The secondary endpoint was the comparison of these measures with those derived from the water drinking test (WDT). Methods: Thirty patients with primary open-angle glaucoma (POAG) that were undergoing medical therapy and 30 healthy subjects were enrolled in this study. Each patient underwent a diurnal curve between 8 am and 4 pm. After lying down for 5 minutes, the IOP was measured with the Perkins tonometer. Patients were instructed to sit in the upright position for 5 minutes and the tonometry was repeated. At 4:15 pm, the WDT test was performed. Fluctuation was defined as the difference between the highest and the lowest IOP readings (range). The Student's t test was used to assess differences and a P value <0.05 was considered to be statistically significant. Results: The diurnal curve in the supine position demonstrated higher IOP average values (on average 3-4 mmHg higher) compared to the sitting position (p<0.0001) for both groups. IOP peaks were higher in the supine position; however, the IOP range was essentially the same between the three methods. Treated glaucomatous patients had higher IOP levels in all measurements, but the fluctuation for all tests performed appeared to be similar to that of healthy patients. Conclusion: The data suggested that WDT can be used to estimate the diurnal IOP peak and fluctuation observed in the SDTC of the supine position for treated glaucomatous patients. Further studies can compare the possible correlation between the WDT results and those obtained from nocturnal supine measurements.Objetivo: Comparar a flutuação da pressão intraocular (PIO) nas posições sentada e supina, através da curva tensional diária simplificada (CTDS), durante o horário de consultório em pacientes saudáveis e com glaucoma primário de ângulo aberto (GPAA). O objetivo secundário foi comparar estas medidas com a flutuação da PIO verificada através do teste de sobrecarga hídrica (TSH) desses dois grupos. Métodos: A amostra foi constituída por 60 indivíduos, divididos em dois grupos, 30 saudáveis e 30 glaucomatosos. Nenhum dos pacientes saudáveis usava medicação anti-glaucomatosa. Entre os portadores de glaucoma, todos estavam medicados. Foi realizada a CTDS (medidas realizadas entre 8:00 h e às 16:00 h) na posição sentada e supina utilizando o mesmo tonômetro de Perkins. Imediatamente após a última medida (às 16:15 h), foi realizado o TSH. Flutuação foi definida como a diferença entre a maior e a menor medida de PIO. O teste t-Student foi usado para analisar as diferenças e o valor de p<0,05 foi considerado estatisticamente significante. Resultados: Os picos de PIO foram sempre maiores na CTDS quando medidos na posição supina (em média 4 mmHg maior) em pacientes saudáveis e pacientes glaucomatosos em tratamento, comparado a posição sentada (p<0.0001). Pacientes glaucomatosos em tratamento apresentaram PIO mais alta em todas as medidas, porém a flutuação em todos os testes realizados foi semelhante comparada aos pacientes saudáveis. A flutuação da PIO não apresentou diferença estatística entre os 3 métodos. Conclusão: Dados sugerem que o TSH pode ser usado para estimar o pico e a flutuação diurna da PIO na posição supina na CTDS em pacientes glaucomatosos em tratamento. Estudos futuros poderão avaliar uma possível correlação entre os resultados do TSH e as medidas noturnas em posição supina.Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina (EPM) Department of Ophthalmology and Visual SciencesSanta Casa de Misericórdia de São Paulo Department of Ophthalmology Glaucoma SectorUNIFESP, EPM, Department of Ophthalmology and Visual SciencesSciEL

Spectral-Domain Optical Coherence Tomography for Macular Edema

Optical coherence tomography (OCT) is a rapid noncontact method that allows in vivo imaging of the retina and it has become an important component in clinical practice. OCT is a useful ancillary tool for assessing retinal diseases because of its ability to provide cross-sectional retinal images and quantitatively analyze retinal morphology. the introduction of spectral-domain OCT provided major improvements in image acquisition speed and image resolution. Future studies will address how these major technologic advances will impact the use of OCT in research and clinical practice.Universidade Federal de São Paulo, Dept Ophthalmol, BR-06023062 São Paulo, BrazilUniversidade Federal de São Paulo, Dept Ophthalmol, BR-06023062 São Paulo, BrazilWeb of Scienc

Daily Optical Coherence Tomography Examinations after First Antivascular Endothelial Growth Factor Injections: An Interventional Case Series

Purpose. To evaluate daily spectral-domain optical coherence tomography (SD-OCT) changes in naive-treatment patients with diagnosis of exudative age-related macular degeneration (AMD) treated with intravitreous bevacizumab (1.25 mg), during a 30-day follow-up period. Methods. In prospective, interventional study, SD-OCT was performed daily for 30 days after the first intravitreal injection. The baseline, initial-decrease, minimal, and final central retinal thicknesses (CRTs) were assessed. Results. Nine eyes of nine patients with neovascular AMD were enrolled. The mean baseline CRT was 625.3±182.5 μm, and the mean final CRT was 383.4±163.0 μm (mean difference, 206.1±167.6 μm), a difference that reached significance (P=0.006). After the first injection, the initial decrease in the CRT was seen as an average of one day after injection (mean CRT, 503.6±189.10 μm; P=0.0431). The speed of the reduction in the CRT tended to decrease by day 17. The mean CRT was 336.5±105.44 μm and the mean minimal CRT on day 30 was 320.75±96.38 μm. Conclusion. The CRT decreased early after the first injection. We observed a tendency for reductions in the speed with which the CRT decreased by day 17 after the first injection, which may affect retreatment regime

Investigação da incidência dos tipos de metaplasia intestinal gástrica através de ensaios histoquímicos combinados HID-PAS (High Iron Diamine – Periodic Acid Schiff) e HID-AB (High Iron Diamine – Alcian Blue) empregados na sua identificação

-Introdução: No Brasil, segundo o Instituto Nacional do Câncer para os anos de 2008 e 2009, o adenocarcinoma gástrico será a quinta maior neoplasia em freqüência e a segunda em mortalidade, acompanhando o perfil observado no mundo. A metaplasia intestinal é a transformação da mucosa gástrica para um epitélio com características histológicas intestinais. O adenocarcinoma gástrico tem na sua seqüência de eventos etiopatogênicos a gastrite pelo Helicobacter pylori (Hp), alterações inflamatórias, metaplasia intestinal, mutações genéticas e displasia epitelial. São identificados histoquimicamente três tipos de metaplasia intestinal, tipo I (completa), II e III (incompletas). Os tipos II e III estão associados a mutações genéticas e adenocarcinoma, sendo a presença de sulfomucina (tipo III) indicativa de maior risco de malignização. Já a tipo I raramente se maligniza. O desenvolvimento de métodos de identificação dos tipos de metaplasia se torna vital à prevenção do câncer. Objetivo: Nosso projeto visa estudar a incidência dos tipos de metaplasia intestinal gástrica através do uso da combinação dos ensaios histoquímicos HID-PAS (High Iron Dinamine Periodic Acid Schiff) e HID-AB (High Iron Dinamine Alcian Blue), ainda não muito difundidos no meio, em fragmentos de biópsias gástricas a serem realizados em um laboratório privado, em casos com o diagnóstico de metaplasia intestinal. Metodologia: Preparo dos reagentes e padronização dos ensaios histoquímicos para a identificação dos tipos de metaplasia intestinal. Com a finalidade de avaliar a relevância do problema e o impacto desta técnica na detecção de alterações precursoras do adenocarcinoma, levantamos as biópsias gástricas do arquivo do laboratório de patologia no período de fevereiro de 2007 a agosto de 2008 para cruzamento de dados. Os parâmetros levantados foram: presença de gastrite crônica, infecção pelo Hp, e a presença e intensidade (leve, moderada e intensa) de metaplasia intestinal. A partir destes dados, procedemos a análises estatísticas. Resultados: A padronização das técnicas histoquímicas encontra-se na fase de testes.A análise da casuística das 7994 biópsias gástricas referentes ao período, 73,19% eram de gastrite, sendo que dessas 29,0% foram classificadas como moderada a grave. Além disso, 10,8% foram de metaplasia intestinal, sendo que dessas 65,5% foram moderada a grave. 25,4% foram positivas para a presença de Hp. Conclusão: A análise dos dados apresentados indica que a incidência de metaplasia é expressiva, tornando imprescindível a indicação destes ensaios histoquímicos (HID-PAS e HID-AB) para detecção de pacientes mais propensos ao desenvolvimento de adenocarcinoma. Baseados nestes dados propomos a incorporação dessas técnicas histoquímicas na rotina dos laboratórios de patologia da rede pública e privada, bem como o oferecimento das mesmas às empresas operadoras de saúde, para a inclusão de pacientes em protocolo de acompanhamento para prevenção do adenocarcinoma gástrico

Twelve-Month Follow-Up of Dexamethasone Implants for Macular Edema from Various Diseases in Vitrectomized and Nonvitrectomized Eyes

Purpose. To evaluate the best-corrected visual acuity (BCVA), central retinal thickness (CRT), and the number of dexamethasone implants needed to treat cystoid macular edema (CME) from various etiologies over 12 months in vitrectomized and nonvitrectomized eyes. Methods. This multicenter retrospective cohort study included 112 patients with CME secondary to retinal diseases treated pro re nata (PRN) with a 0.7 mg intravitreal dexamethasone implant for 12 months. The BCVA, CRT, adverse events, safety data, and number of implants were recorded. Results. Vitrectomized and nonvitrectomized eyes received means of three implants and one implant, respectively, over 12 months (P<0.001). The mean BCVA of all patients improved from 0.13 at baseline to 0.33 (P<0.001) 12 months after one (P=0.001), two (P=0.041), and three (P<0.001) implants but not four implants (P=0.068). The mean baseline CRT decreased significantly (P<0.001) from 463 to 254 microns after 12 months with one (P<0.001), two (P=0.002), and three (P=0.001) implants but not with four implants (P=0.114). The anatomic and functional outcomes were not significantly different between vitrectomized and nonvitrectomized eyes. Increased IOP was the most common adverse event (23.2%). Conclusions. Dexamethasone implant administered PRN improved VA and decreased CRT in CME, with possible long-term clinically relevant benefits for treating CME from various etiologies. Vitrectomized eyes needed more implants compared with nonvitrectomized eyes

Intraocular pressure fluctuation in healthy and glaucomatous eyes: a comparative analysis between diurnal curves in supine and sitting positions and the water drinking test

Purpose: To compare intraocular pressure (IOP) using the simplified daily tensional curve (SDTC) between supine and sitting positions in terms of peak levels and amount of fluctuation in both, glaucomatous and healthy subjects. The secondary endpoint was the comparison of these measures with those derived from the water drinking test (WDT). Methods: Thirty patients with primary open-angle glaucoma (POAG) that were undergoing medical therapy and 30 healthy subjects were enrolled in this study. Each patient underwent a diurnal curve between 8 am and 4 pm. After lying down for 5 minutes, the IOP was measured with the Perkins tonometer. Patients were instructed to sit in the upright position for 5 minutes and the tonometry was repeated. At 4:15 pm, the WDT test was performed. Fluctuation was defined as the difference between the highest and the lowest IOP readings (range). The Student's t test was used to assess differences and a P value <0.05 was considered to be statistically significant. Results: The diurnal curve in the supine position demonstrated higher IOP average values (on average 3-4 mmHg higher) compared to the sitting position (p<0.0001) for both groups. IOP peaks were higher in the supine position; however, the IOP range was essentially the same between the three methods. Treated glaucomatous patients had higher IOP levels in all measurements, but the fluctuation for all tests performed appeared to be similar to that of healthy patients. Conclusion: The data suggested that WDT can be used to estimate the diurnal IOP peak and fluctuation observed in the SDTC of the supine position for treated glaucomatous patients. Further studies can compare the possible correlation between the WDT results and those obtained from nocturnal supine measurements

Effectiveness of monthly and fortnightly anti-VEGF treatments for age-related macular degeneration

ABSTRACT Purpose: To study the efficacy and safety of treatments with ranibizumab and bevacizumab for exudative age-related macular degeneration. Methods: A parallel randomized clinical trial was conducted to compare the efficacy and safety of three regimens (bevacizumab every month, bevacizumab every 2 weeks, and ranibizumab every month), followed by as-needed retreatments, for 1 year, in previously untreated individuals with age-related macular degeneration. The primary outcome was change in visual acuity and in central macular thickness after 1 year of follow-up. Subjects were assigned randomly to one of the three groups in a 1:1:1 ratio, and investigators and examiners were blinded to the randomization results. Results: We included 15 patients in each group. After 1 year of follow-up, we found statistically significant improvements in visual acuity and central macular thickness reduction in all groups. However, we found no statistically significant differences between the three groups. Conclusions: The bi-weekly follow-up was effective and we found no significant differences in efficacy or safety between the treatments with ranibizumab and bevacizumab

Retinal Biocompatibility of Brilliant Blue G with Deuterated Water for Chromovitrectomy

Purpose: To investigate the retinal biocompatibility of Brilliant Blue G with deuterated water (BBG-D2O) as a vital dye for chromovitrectomy. Methods: In this animal study, 0.05 mL of 0.25 g/L Brilliant Blue G (BBG) associated with 0.13 mL/mL of deuterium oxide (D2O) was injected intravitreally in the right eye and the same amount of balanced salt solution (BSS) was injected similarly in the left eye of rabbits. Clinical examination and histology with light microscopy were performed after seven days. Retinal cell layers were evaluated for morphologic alterations. Electroretinographic (ERG) changes were also assessed at baseline and 7 days after the injections. Results: A total of 6 rabbits were included in the study. The gross histopathologic appearance of the retina, choroid, sclera and optic nerve was within normal limits without any sign of severe retinal necrosis or cystic degeneration. Light microscopy showed that BBG-D2O caused no substantial alterations in retinal layers as compared to control eyes. The injection of BBG-D2O did not induce considerable functional ERG alterations. Conclusion: Intravitreal injection of BBG-D2O 0.25 g/L seems to induce no retinal toxicity as documented by lack of functional and histological changes

Combined results of effect of vital dyes on ARPE-19 cells.

<p>The effects of dyes on cell viability were combined for each concentration and compared between 3 and 30 minutes of exposure. Bars correspond to means of three independent experiments. Data are expressed as percentage of control, and the results shown are mean results ± SEM of three independent experiments run in triplicate on cultured cells. Statistical significance is indicated by *P<0.01 for comparison with the control.</p

Effect of different doses of indocyanine green (ICG), acid violet (AcV), brilliant blue (BriB) and methyl blue (MetB) on ARPE-19 cells viability assessed by MTS cell assay.

<p>Cells were exposed to dyes for 3 minutes. Bars correspond to means of three independent experiments. Data are expressed as percentage of control, and the results shown are mean results ± SEM of three independent experiments run in triplicate on cultured cells. Statistical significance is indicated by **P<0.01 and for comparison with the control (BSS solution).</p