Phacoemulsification Versus Peripheral Iridotomy in the Management of Chronic Primary Angle Closure: Long-Term Follow-Up

Primary angle closure occurs as a result of crowded anterior segment anatomy, causing appositional contact between the peripheral iris and trabecular meshwork, thereby obstructing aqueous outflow. Several studies highlight the role of the crystalline lens in its pathogenesis. The objective of this work is to compare the long-term efficacy of phacoemulsification versus laser peripheral iridotomy (LPI) in the management of chronic primary angle closure (CPAC). Prospective case-control study with 30 eyes of 30 patients randomly divided in two groups: 15 eyes in the LPI group and 15 eyes in the IOL group. Patients in the LPI group underwent LPI using argon and Nd:YAG laser. Patients in the IOL group underwent phacoemulsification with posterior chamber intraocular lens (IOL) implantation. Examinations before and after the procedure included gonioscopy, Goldmann applanation tonometry, and anterior chamber evaluation using the Pentacam rotating Scheimpflug camera. The mean follow-up time was 31.13 ± 4.97 months. There was a statistically significant reduction in the intraocular pressure (IOP) and number of anti-glaucoma medications (p < 0.01) only in the IOL group. Anterior chamber depth, angle, and volume were all higher in the IOL group (p < 0.01) at the end of the follow-up period. Phacoemulsification with posterior chamber IOL implantation results in a higher anterior chamber depth, angle, and volume, when compared to LPI. Consequently, phacoemulsification has greater efficacy in lowering IOP and preventing its long-term increase in patients with CPAC and cataract

Diabetic Choroidopathy: a Review of the Current Literature

Diabetic retinopathy is an increasingly prevalent disease, and a leading contributor to the burden of all-cause blindness worldwide. In addition to retinal changes, choroidal abnormalities are common in patients with diabetes. The first studies concerning this vascular structure were based on histologic, indocyanine angiography and laser Doppler flowmetry techniques, but the development of new optical coherence tomography (OCT) technologies and imaging software for enhanced depth imaging (EDI)-OCT in recent years has made it possible to provide more detailed images of the choroidal anatomy and topography.In diabetic patients, several choroidal changes have been described in the literature throughout the years; the recent focus is choroidal thickness, which is significantly different from that in healthy patients. However, understanding choroidal manifestations of diabetic eye disease remains a real challenge, and this gap is hindering efforts towards better defining choroidal evaluation as a predictive factor for disease evolution and treatment response.This review aims to summarize the recent literature concerning changes in choroidal structure in diabetic patients, the relationship to diabetic retinal disease progression, and finally, the current and potential application of the measurement of variations in choroidal thickness for patient management.info:eu-repo/semantics/publishedVersio

Atividade Física e Exercício Físico: Especificidades no Doente Cardíaco

A atividade física é atualmente um comportamento de grande importância para a promoção de um estilo de vida saudável, contudo vários estudos têm demonstrado elevada prevalência de inatividade e comportamentos sedentários nas pessoas com doença cardiovascular. Uma prática regular de atividade física e de exercício físico em níveis adequados assegura diversos benefícios para a pessoa com doença cardiovascular. Programas de reabilitação cardíaca e de prevenção secundária têm como um dos principais objetivos o incentivo à adoção de estilos de vida mais ativos. Neste artigo de revisão, os conceitos e recomendações sobre a atividade física e o exercício físico estruturado em pessoas com doença cardiovascular, vão ser abordados

Impacto do Diâmetro do Nervo Óptico na Amplitude de Pulso Ocular no Glaucoma Primário de Ângulo Aberto

Introdução: A pressão intra-craniana (PIC) tem sido descrita como estando envolvida no glaucoma primário de ângulo aberto (GPAA). A sua avaliação está contudo limitada pela necessidade de métodos invasivos, como a punção lombar. A ecografia ocular permite uma avaliação indirecta da PIC através da medição do diâmetro da bainha do nervo óptico (NO). Desconhece-se se esta nova variável tem capacidade de modular factores de risco normalmente investigados em doentes com GPAA. Objectivo: Avaliar o impacto do diâmetro da bainha do NO na pressão intra-ocular (PIO) e na amplitude de pulso ocular (OPA) de doentes com GPAA. Métodos: Quinze doentes com GPAA foram submetidos a medição da PIO por tonometria de contorno dinâmico, avaliação topográfica do disco óptico e ecografia ocular modo B com sonda doppler. Apenas o olho com maior dano glaucomatoso foi seleccionado por doente. Resultados: A média do diâmetro da bainha do NO foi de 5,6±0,67mm, a PIO média de 17,8±2,2mmHg e a OPA de 3,1±1,7mmHg. O diâmetro da bainha do NO correlacionou-se negativamente a OPA (r=-0.54, p=0.05), não tendo influenciado a PIO (r=-0,25, p=0,41). Da avaliação hemodinâmica, apenas o índice de resistência da artéria central da retina (CRA) foi influenciado pelo diâmetro da bainha do NO (r=-0.52, p=0.04). Conclusão: O diâmetro da bainha do NO correlaciona-se negativamente com a OPA. Este efeito poderá ser explicado pela alteração da resistência vascular da artéria que atravessa este espaço subaracnoideu, a CRA. O estudo da região retrobulbar e do balanço entre as pressões aí exercidas é assim um campo cuja importância será crescente na avaliação do doente com GPAA

Análise da Repercussão de uma Sessão Educativa sobre o Glaucoma no Conhecimento da Doença

Introdução: A adesão à terapêutica antiglaucomatosa é fundamental na redução e controlo da pressão intra-ocular. Os doentes com menor nível de conhecimento sobre a sua doença apresentam taxas de não adesão terapêutica superiores. Este estudo tem como objectivo a avaliação da repercussão de uma sessão de esclarecimento sobre o glaucoma e seu tratamento. Material e métodos: Estudo prospectivo que incluiu 24 doentes seguidos em consulta de glaucoma. Procedeu-se ao preenchimento de um questionário validado, sobre a doença e o seu tratamento. De seguida os doentes assistiram a uma sessão de esclarecimento sobre o glaucoma. O preenchimento do questionário foi repetido após a sessão e ao fim de 1 mês. Resultados: A idade média foi 63,7 anos, 45,8% era do sexo feminino. Em 9 das 22 perguntas, mais de 50% dos doentes responderam acertadamente antes da sessão educativa. Após a realização da mesma foram 13 as respostas acertadas por mais de 50% dos doentes (p0,05) e o nível de escolaridade (p>0,05). Conclusão: Através da sessão educativa houve uma melhoria dos conhecimentos dos doentes com glaucoma, relativamente à sua doença

Avaliação do Conhecimento sobre a sua Doença em Doentes com Glaucoma seguidos na Consulta de Especialidade de um Hospital Central

Objectivo: Avaliar e comparar com a população geral o nível de conhecimento sobre a doença e o seu tratamento em doentes com glaucoma. Doentes e Métodos: Noventa doentes com glaucoma e 90 doentes sem glaucoma foram entrevistados no departamento de glaucoma e de consulta geral do Centro Hospitalar de Lisboa Central. Foi solicitado o preenchimento de um questionário validado sobre a doença e o seu tratamento. Foram registados dados demográficos. Resultados: Dezoito porcento e 51% dos doentes,respectivamente, com glaucoma e controlo, desconheciam a doença. Em 6 das 22 perguntas, mais de 50% dos doentes responderam acertadamente. Em 16 perguntas o número de respostas correctas dos doentes foi inferior a 50%. Os doentes com glaucoma têm um nível de conhecimentos superior (p=7,9x10-6) ao grupo controlo. O nível de conhecimento é maior quanto maior a duração da doença (p=0,03) e o nível de escolaridade (p=0,0065). Comentários: Os doentes com glaucoma têm um nível de conhecimentos sobre a sua doença superior ao grupo controlo, não obstante ambos os grupos terem um conhecimento insuficiente. Devem ser tomadas medidas de prevenção primária e secundária, com recurso a material educacional, com o objectivo de melhorar os conhecimentos dos doentes e consequentemente a compliance

Long-Term Outcomes of Standard Endovascular Aneurysm Repair in Patients With Severe Neck Angulation

Objective: Severe neck angulation is associated with complications after endovascular aneurysm repair (EVAR). Newer endografts may overcome this limitation, but the literature lacks long-term results. We studied the long-term outcomes of EVAR in patients with severe neck angulation. Methods: A retrospective case-control study of a prospective multicenter database was performed. All measurements were made with dedicated software with center lumen line reconstruction. A study group including patients with neck length >15 mm, infrarenal angle (β) >75 degrees or suprarenal angle (α) >60 degrees, and neck length 10 to 15 mm with β >60 degrees or α >45 degrees was compared with a control group matched for demographics and other morphologic neck features. The primary end point was type IA endoleak (EL1A). Secondary end points were freedom from neck-related secondary interventions, primary clinical success, and overall survival. Results: Forty-five patients were included in the angulated neck group and compared with 65 matched patients. Median follow-up was 7.4 years (interquartile range, 4.8-8.5 years). In the angulated neck group, mean α was 51.4 degrees (±21.1 degrees) and the mean β was 80.8 degrees (±15.6 degrees); in the nonangulated group, these were 17.9 degrees (±17.0 degrees) and 35.4 degrees (±20.0 degrees), respectively. At 7 years, five patients in the angulated neck group and two nonangulated patients developed EL1A, yielding a freedom from EL1A of 86.1% (n = 14; standard error [SE], 0.069) and 96.6% (n = 34; SE, 0.023), respectively (P = .056). After exclusion of a patient who developed an EL1A secondary to an endograft infection, this difference was significant: 86.1% (n = 14; SE, 0.069) in the angulated neck group and 98.2% (n = 34; SE, 0.018) in the nonangulated group (P = .016). At 7 years, freedom from neck-related secondary interventions was 91.7% (n = 14; SE, 0.059) and 91.6% (n = 29; SE, 0.029), respectively. The 7-year primary clinical success estimates were 41.2% (n = 11; SE, 0.085) and 56.6% (n = 20; SE, 0.072) for the angulated neck and nonangulated groups, respectively (P = .12). The 7-year survival rates were 44.3% (n = 18; SE, 0.076) vs 66.7% (n = 42; SE, 0.059) for the angulated neck and nonangulated groups, respectively (P = .25). Device integrity failure was not observed. Conclusions: Despite satisfactory results early and in the midterm, a higher rate of EL1A was identified among patients with severely angulated necks in the long term. However, mortality was not affected by this difference. These findings suggest that EVAR should be used judiciously in patients with extreme angulation of the proximal neck and highlight the need for close follow-up of EVAR, especially in the long term and in patients treated outside instructions for use.info:eu-repo/semantics/publishedVersio

Retina and Choroid of Diabetic Patients Without Observed Retinal Vascular Changes: A Longitudinal Study

PURPOSE: To identify changes in choroidal thickness (CT) and all retinal layers of diabetic patients without diabetic retinopathy (DR) after 1 year of follow-up. DESIGN: Prospective observational cohort study. METHODS: Overall, 125 diabetic patients without DR were included. Two visits were scheduled: the first visit (V1) and a second visit after 12 months (V2). At both visits, patients received a complete ophthalmologic evaluation that included OCT. Each retinal layer thickness was calculated for 9 ETDRS sectors, and CT was measured at 13 locations. Generalized linear mixed-effects models were used. RESULTS: Of the 125 patients, 103 completed the study, and 9 of the 103 developed DR (8.7%). CT was significantly higher at V2 than at V1, with an average value of 10-17 μm at almost half the locations (500, 1000, and 1500 μm temporal; 500 and 1000 μm nasal; and 1000 μm superior to the fovea) (P < .001-.003). The thicknesses of the ganglion cell layer (I3 and N6 sectors), inner plexiform layer (S6 and N6 sectors), inner nuclear layer (T6 and N6 sectors), and outer plexiform layer (S6 sector), as well as the overall retinal thickness (RT) (S3, N3, I3, S6, and T6 sectors), were decreased at V2 (P < .001). Visible retinopathy was negatively associated with overall RT (central, S3, T3, I3, and N3 sectors, P = .004-.024) and the thickness of the ONL (T6 and I6 sectors, P = .007 and P = .009) and photoreceptor layer (N6 sector, P = .038). The presence of DR decreased the overall RT by 13.04-16.63 μm. CONCLUSIONS: Diabetic patients without DR showed a thicker choroid and a thinner retina, particularly in inner layers, after 1 year of follow-up. These structural changes may correspond to the early neurodegenerative phase of DR.info:eu-repo/semantics/publishedVersio

Choroidal Thickness in Nonarteritic Anterior Ischaemic Optic Neuropathy: A Study with Optical Coherence Tomography

Nonarteritic anterior ischemic optic neuropathy (NA-AION) is the most common nonglaucomatous optic neuropathy in adults over 50 years of age. It is usually related to cardiovascular risk factors. The primary objective of this study was to evaluate choroidal thickness in patients with chronic NA-AION, and the secondary objective was to evaluate macular thickness in these patients. This cross-sectional study compared two groups: group 1 included 20 eyes of 20 patients with chronic NA-AION, and group 2 included 31 eyes of 31 healthy controls. In both groups, the choroidal thickness was measured using the enhanced depth imaging program of Heidelberg Spectralis® optical coherence tomography (Heidelberg Engineering, Heidelberg, Germany). The macular thickness was also measured using the automatic software of the same device. The mean follow-up time after NA-AION in group 1 was 57.17 ± 26.92 months. The mean choroidal thickness of the posterior pole was 244.38 ± 61.03 µm in group 1 and 214.18 ± 65.97 µm in group 2 (p = 0.004). The mean macular thickness was higher in group 2. Macular thickness is reduced in eyes that had an episode of NA-AION, whereas choroidal thickness is generally higher in these eyes when compared with normal eyes. The increase in choroidal thickness may be due to a local dysfunction in vascular autoregulatory mechanisms, which may predispose to ischemic phenomena.info:eu-repo/semantics/publishedVersio