O uso de lágrimas artificiais em pacientes com glaucoma: um estudo retrospectivo e comparativo

PURPOSE: To evaluate the need for artificial tears by glaucoma patients under topical hypotensive treatment and to identify risk factors associated with it. METHODS: The charts of 175 glaucoma patients under medical treatment and 175 age-matched controls were reviewed. Age, gender, use of artificial tears, number of glaucoma medications used, and duration of treatment were recorded. RESULTS: Significantly more glaucoma patients (n=92; 52.6%) used artificial tears compared to age-matched controls (n=31; 17.7%) (p<0.001). Significantly more females (n=81; 39%) than males (n=42; 28.9%) used artificial tears (p=0.036). When the whole population was analyzed, female gender (OR=1.63) and the presence of glaucoma (OR= 5.14) were risk factors for the use of artificial tears (p<0.05). When the glaucoma population was analyzed, female gender (OR=2.57), number of medications &gt;2 (OR=1.92), and duration of treatment &gt;5 years (OR=2.93) were risk factors for the use of artificial tears (p<0.05). CONCLUSIONS: Topical treatment with antiglaucoma medication is a risk factor for the use of artificial tears. Female gender and long-term treatment of glaucoma with two or more medications were aggravating factors for the need for artificial tears.OBJETIVO: Avaliar a necessidade do uso de lágrimas artificiais por pacientes com glaucoma recebendo tratamento medicamentoso e identificar fatores de risco associados ao seu uso. MÉTODOS: Os prontuários de 175 pacientes com glaucoma sob tratamento medicamentoso e de 175 controles pareados por idade foram revistos. Os seguintes dados foram registrados: idade, sexo, uso de lágrimas artificiais, número de medicações antiglaucomatosas e duração do tratamento do glaucoma. RESULTADOS: Um número significativamente maior de pacientes com glaucoma (n=92; 52,6%) usava lágrimas artificiais em relação ao grupo controle (n=31; 17,7%) (p<0,001). Um número significativamente maior de mulheres (n=81; 39%) usava lágrimas artificias em relação aos homens (n=42; 28,9%) (p=0,036). Quando a população foi analisada como um todo, sexo feminino (OR=1,63) e presença de glaucoma (OR=5,14) foram fatores de risco para o uso de lágrimas artificiais (p<0,05). Quando apenas a população de glaucomatosos foi analisada, número de medicações &gt;2 (OR=1,92) e duração do tratamento &gt;5 anos (OR=2,93) foram fatores de risco para o uso de lágrimas artificiais (p<0,05). CONCLUSÕES: O tratamento com colírios antiglaucomatosos é um fator de risco para o uso de lágrimas artificiais. Sexo feminino e tratamento a longo prazo com duas ou mais medicações são fatores de risco adicionais para o uso de lágrimas artificiais.6

Parâmetros biomecânicos derivados da forma da curva do ORA para discriminar olhos normais de ceratocones

PURPOSE: To evaluate the ability of the Ocular Response Analyzer (ORA; Reichert Ophthalmic Instruments, Buffalo, NY) to distinguish between normal and keratoconic eyes, by comparing pressure and waveform signal-derived parameters. METHODS: This retrospective comparative case series study included 112 patients with normal corneas and 41 patients with bilateral keratoconic eyes. One eye from each subject was randomly selected for analysis. Keratoconus diagnosis was based on clinical examinations, including Placido disk-based corneal topography and rotating Scheimpflug corneal tomography. Data from the ORA best waveform score (WS) measurements were extracted using ORA software. Corneal hysteresis (CH), corneal resistance factor (CRF), Goldman-correlated intraocular pressure (IOPg), cornea-compensated intraocular pressure (IOPcc), and 37 parameters derived from the waveform signal were analyzed. Differences in the distributions among the groups were assessed using the Mann-Whitney test. Receiver operating characteristic (ROC) curves were calculated. RESULTS: Statistically significant differences between keratoconic and normal eyes were found in all parameters (p<0.05) except IOPcc and W1. The area under the ROC curve (AUROC) was greater than 0.85 for 11 parameters, including CH (0.852) and CRF (0.895). The parameters related to the area under the waveform peak during the second and first applanations (p2area and p1area) had the best performances, with AUROCs of 0.939 and 0.929, respectively. The AUROCs for CRF, p2area, and p1area were significantly greater than that for CH. CONCLUSION: There are significant differences in biomechanical metrics between normal and keratoconic eyes. Compared with the pressure-derived parameters, corneal hysteresis and corneal resistance factor, novel waveform-derived ORA parameters provide better identification of keratoconus.OBJETIVO: Avaliar a capacidade do Ocular Response Analyzer (ORA; Reichert Ophthalmic Instruments, Buffalo, NY) em discriminar olhos com ceratocone de olhos normais e comparar parâmetros derivados da pressão dos parâmetros derivados da forma da curva. MÉTODOS:Estudo comparativo retrospectivo série de casos que incluiu 112 pacientes com olhos normais e 41 pacientes com ceratocone bilateral. Um olho de cada indivíduo foi randomicamente selecionado para análise. O diagnóstico de ceratocone foi baseado em exame clínico, incluindo topografia de Plácido e tomografia Scheimpflug. Informação do melhor waveform score foi extraída do software do ORA. Histerese corneana (CH), fator de resistência corneana (CRF), pressão intraocular correlacionada com Goldman (IOPg), pressão intraocular compensada pela córnea (IOPcc) e 37 novos parâmetros derivados da forma da curva do sinal do ORA foram analisados. Diferenças nas distribuições dos grupos foram avaliadas pelo teste Mann-Whitney. Curvas ROC foram calculadas. RESULTADOS: Diferenças estatisticamente significantes foram encontradas entre os olhos normais e ceratocones em todos os parâmetros (p<0,05) salvo IOPcc e W1. A área sob a curva ROC (AUROC) foi maior que 0.85 em 11 parâmetros, incluindo CH (0,852) a CRF (0,895). Os parâmetros relacionados com a área sob o pico da forma de onda durante a segunda e primeira aplanação (p2area e p1area) obtiveram as melhores performances, com AUROCs de 0,939 e 0,929, respectivamente. Os valores de AUROCs do fator de resistência corneana, p2area e p1area foram significativamente maiores que os valores de histerese corneana. CONCLUSÃO: Existem diferenças significantes nas medidas biomecânicas entre olhos normais e com ceratocone. Comparados com os parâmetros derivados da pressão, histerese corneana e fator de resistência corneana, os parâmetros derivados da forma da curva proporcionaram melhor identificação dos ceratocones.Universidade Federal de São Paulo (UNIFESP) Department for OphthalmologyHospital de Olhos de SergipeInstituto de Olhos Renato AmbrósioUNIFESP, Department for OphthalmologySciEL

Alumnos de un programa de postgrado en cardiología: ¿Son los resultados de casi 30 años adecuados?

BACKGROUND: Stricto sensu post-graduation in Brazil was implemented in 1965 to increase university professors' teaching quality and to prepare full, independent researchers. The brazilian share in ISI publications has increased significantly since then, but little information is available on postgraduate quality. OBJECTIVE: To review 29 years of the postgraduate programs in cardiology at the Federal University of São Paulo and to analyze master and doctorate graduates' characteristics regarding their origin, publications and subsequent career. METHODS: We developed a questionnaire to evaluate 168 postgraduates who produced 196 theses (116 master's and 80 doctorate) over the period 1975-2004 and contacted 95.9% of them. Information on publications were obtained through the usual science databases. RESULTS: 30% of graduates came from the North-Northeast-Central West regions and only 50% returned to their original area. Mean age at admission was 32.5 and 34.9 years old for master and doctorate students, respectively; average program duration was, respectively, 39.0 and 43.2 months and approximately 50% went through it without any grants. Thesis publications throughout these 29 years averaged 36.5% for master's and 61.9% for doctorate, but any publishing afterwards occurred in 70.2 and 90.6% of the cases. The average impact factor of the published theses was 1.3 for master's degree and 3.1 for doctorate programs with 65.5% and 87.5% of Qualis A, respectively. Currently, there are graduates in 17 states of the country and 12 have became full professors. CONCLUSION: Although the stricto sensu program, especially the master's degree program, has many areas that need improvement, they seem to be contributing to improve professional quality and the number of brazilian indexed publications.FUNDAMENTO: El Postgrado Stricto Sensu en Brasil se implementó en el año 1965 para aumentar la calidad de la enseñanza en las Universidades y preparar a investigadores completos e independientes. La participación brasileña en las publicaciones ISI ha aumentado desde entonces de forma significativa, pero poca información está disponible sobre la calidad de los postgrados. OBJETIVO: Revisar 29 años de programa de postgrado en Cardiología en la Universidad Federal de São Paulo y analizar las características de los alumnos de Maestría y Doctorado con relación al origen, publicaciones y carrera subsiguiente. MÉTODOS: Desarrollamos un cuestionario para evaluar a 168 alumnos de postgrado que produjeron 196 tesis (116 de Maestría y 80 de Doctorado), en el período de 1975-2004 y contactamos el 95,9% de ellos. La informaciones sobre las publicaciones se obtuvieron mediante los banco de datos científicos usuales. RESULTADOS: El 30% de los alumnos de postgrado eran de las regiones Norte-Nordeste-Centro-Oeste y solamente el 50% de ellos retornó a su región de origen. La edad promedio cuando del ingreso en el Postgrado fue de 32,5 años y 34,9 años para alumnos de Maestría y Doctorado, respectivamente; la duración promedio de los programas de postgrado fue respectivamente de 39,0 y 43,2 meses y aproximadamente el 50% de los alumnos hizo el curso de postgrado sin cualquier beca de estudio. La publicación de las tesis durante estos 29 años presentó un promedio del 36,5% para Maestría y el 61,9% para Doctorado, sin embargo, cualesquiera publicaciones posteriores fueron del orden de un 70,2% y un 90,6%, respectivamente. El factor de impacto promedio de la tesis publicada fue de un 1,3 para Maestría y un 3,1 para Doctorado, con un 65,5% y un 87,5% de Qualis A, respectivamente. Actualmente, hay ex-alumnos de postgrado originarios de nuestra institución en 17 estados de la Federación y 12 de ellos se convirtieron en Profesores Titulares. CONCLUSIÓN: Aunque el programa Stricto sensu, especialmente en la Maestría, todavía expresa muchas áreas que necesitan mejoras, él parece estar contribuyendo a mejorar la calidad profesional y de las publicaciones brasileñas indexadas.FUNDAMENTO: A pós-graduação stricto sensu no Brasil foi implementada em 1965 para aumentar a qualidade de ensino nas Universidades e preparar pesquisadores completos e independentes. A participação brasileira nas publicações ISI tem aumentado desde então de forma significante, mas pouca informação está disponível sobre a qualidade dos pós-graduados. OBJETIVO: Revisar 29 anos de programa de pós-graduação em cardiologia na Universidade Federal de São Paulo (UNIFESP) e analisar as características dos alunos de mestrado e doutorado em relação à origem, publicações e carreira subsequente. MÉTODOS: Desenvolvemos um questionário para avaliar 168 alunos de pós-graduação que produziram 196 teses (116 de mestrado e 80 de doutorado), no período de 1975-2004 e entramos em contato com 95,9% deles. As informações sobre as publicações foram obtidas através dos bancos de dados científicos usuais. RESULTADOS: 30% dos alunos de pós-graduação eram das regiões Norte-Nordeste-Centro-Oeste e apenas 50% deles retornou à sua região de origem. A idade média quando da admissão na pós-graduação foi de 32,5 anos e 34,9 anos para mestrandos e doutorandos, respectivamente; a duração média dos programas de pós-graduação foi respectivamente de 39,0 e 43,2 meses e aproximadamente 50% dos alunos fez o curso de pós-graduação sem qualquer bolsa de estudo. A publicação das teses durante esses 29 anos apresentou uma média de 36,5% para mestrado e 61,9% para doutorado, mas quaisquer publicações posteriores foram da ordem de 70,2% e 90,6%, respectivamente. O fator de impacto médio da tese publicada foi de 1,3 para mestrado e 3,1 para doutorado, com 65,5% e 87,5% de Qualis A, respectivamente. Atualmente, há ex-alunos de pós-graduação originários de nossa instituição em 17 estados da federação e 12 deles tornaram-se professores titulares. CONCLUSÃO: Embora o programa stricto sensu, especialmente no mestrado, ainda apresente muitas áreas que necessitam de melhoras, ele parece estar contribuindo para melhorar a qualidade profissional e das publicações brasileiras indexadas.Universidade Federal de São Paulo (UNIFESP)UNIFESPSciEL

Corneal Biomechanics in Ectatic Diseases: Refractive Surgery Implications.

BACKGROUND: Ectasia development occurs due to a chronic corneal biomechanical decompensation or weakness, resulting in stromal thinning and corneal protrusion. This leads to corneal steepening, increase in astigmatism, and irregularity. In corneal refractive surgery, the detection of mild forms of ectasia pre-operatively is essential to avoid post-operative progressive ectasia, which also depends on the impact of the procedure on the cornea. METHOD: The advent of 3D tomography is proven as a significant advancement to further characterize corneal shape beyond front surface topography, which is still relevant. While screening tests for ectasia had been limited to corneal shape (geometry) assessment, clinical biomechanical assessment has been possible since the introduction of the Ocular Response Analyzer (Reichert Ophthalmic Instruments, Buffalo, USA) in 2005 and the Corvis ST (Oculus Optikgerate GmbH, Wetzlar, Germany) in 2010. Direct clinical biomechanical evaluation is recognized as paramount, especially in detection of mild ectatic cases and characterization of the susceptibility for ectasia progression for any cornea. CONCLUSIONS: The purpose of this review is to describe the current state of clinical evaluation of corneal biomechanics, focusing on the most recent advances of commercially available instruments and also on future developments, such as Brillouin microscopy.(undefined)info:eu-repo/semantics/publishedVersio

Evaluation of Intereye Corneal Asymmetry in Patients with Keratoconus. A Scheimpflug Imaging Study

Purpose: To assess the correlation between keratoconus severity and intereye asymmetry of pachymetric data and posterior elevation values and to evaluate their combined accuracy in discriminating normal corneas from those with keratoconus. Methods: This study included 97 patients: 65 subjects with bilateral normal corneas (NC) and 32 with keratoconus (KC). Central corneal thickness (CCT), thinnest corneal thickness (ThCT) and posterior elevation (PE) at the thinnest point of the cornea were measured in both eyes using Scheimpflug imaging. Intereye asymmetry and its correlation with keratoconus severity were calculated for each variable. The area under the receiver operating characteristic curve (AUROC) was used to compare predictive accuracy of different variables for keratoconus. Results: In normal eyes, intereye differences were significantly lower compared with the keratoconus eyes (p<0.001, for CCT, ThCT and PE). There was a significant exponential correlation between disease severity and intereye asymmetry of steep keratometry (r(2) = 0.55, p<0.001), CCT (r(2) = 0.39, p<0.001), ThCT (r(2) = 0.48, p<0.001) and PE (r(2) = 0.64, p<0.001). After adjustment for keratoconus severity, asymmetry in thinnest pachymetry proved to be the best parameter to characterize intereye corneal asymmetry in keratoconus. This variable had high accuracy and significantly better discriminating ability (AUROC: 0.99) for KC than posterior elevation (AUROC: 0.96), ThCT (AUROC: 0.94) or CCT (AUROC: 0.92) alone. Conclusions: There is an increased intereye asymmetry in keratometry, pachymetry and posterior corneal elevation values in keratoconic patients compared to subjects with normal corneas. Keratoconus patients with more severe disease are also more asymmetric in their disease status which should be taken into account during clinical care

Determination of Corneal Biomechanical Behavior in-vivo for Healthy Eyes Using CorVis ST Tonometry: Stress-Strain Index

Purpose: This study aims to introduce and clinically validate a new algorithm that can determine the biomechanical properties of the human cornea in vivo.Methods: A parametric study was conducted involving representative finite element models of human ocular globes with wide ranges of geometries and material biomechanical behavior. The models were subjected to different levels of intraocular pressure (IOP) and the action of external air puff produced by a non-contact tonometer. Predictions of dynamic corneal response under air pressure were analyzed to develop an algorithm that can predict the cornea's material behavior. The algorithm was assessed using clinical data obtained from 480 healthy participants where its predictions of material behavior were tested against variations in central corneal thickness (CCT), IOP and age, and compared against those obtained in earlier studies on ex-vivo human ocular tissue.Results: The algorithm produced a material stiffness parameter (Stress-Strain Index or SSI) that showed no significant correlation with both CCT (p &gt; 0.05) and IOP (p &gt; 0.05), but was significantly correlated with age (p &lt; 0.01). The stiffness estimates and their variation with age were also significantly correlated (p &lt; 0.01) with stiffness estimates obtained earlier in studies on ex-vivo human tissue.Conclusions: The study introduced and validated a new method for estimating the in vivo biomechanical behavior of healthy corneal tissue. The method can aid optimization of procedures that interfere mechanically with the cornea such as refractive surgeries and introduction of corneal implants

Ex-vivo experimental validation of biomechanically-corrected intraocular pressure measurements on human eyes using the CorVis ST

The purpose of this study was to assess the validity of the Corvis ST (Oculus; Wetzlar, Germany) biomechanical correction algorithm (bIOP) in determining intraocular pressure (IOP) using experiments on ex-vivo human eyes. Five ex-vivo human ocular globes (age 69 ± 3 years) were obtained and tested within 3–5 days post mortem. Using a custom-built inflation rig, the internal pressure of the eyes was controlled mechanically and measured using the CorVis ST (CVS-IOP). The CVS-IOP measurements were then corrected to produce bIOP, which was developed for being less affected by variations in corneal biomechanical parameters, including tissue thickness and material properties. True IOP (IOPt) was defined as the pressure inside of the globe as monitored using a fixed pressure transducer. Statistical analyses were performed to assess the accuracy of both CVS-IOP and bIOP, and their correlation with corneal thickness. While no significant differences were found between bIOP and IOPt (0.3 ± 1.6 mmHg, P = 0.989) using ANOVA and Bonferroni Post-Hoc test, the differences between CVS-IOP and IOPt were significant (7.5 ± 3.2 mmHg, P < 0.001). Similarly, bIOP exhibited no significant correlation with central corneal thickness (p = 0.756), whereas CVS-IOP was significantly correlated with the thickness (p < 0.001). The bIOP correction has been successful in providing close estimates of true IOP in ex-vivo tests conducted on human donor eye globes, and in reducing association with the cornea's thickness