Early transconjunctival needling revision with 5-fluorouracil versus medical treatment in encapsulated blebs: a 12-month prospective study

OBJECTIVE: To compare the efficacy of transconjunctival needling revision with 5-fluorouracil versus medical treatment in glaucomatous eyes with uncontrolled intraocular pressure due to encapsulated bleb after trabeculectomy. METHODS: Prospective, randomized, interventional study. A total of 40 eyes in 39 patients with elevated intraocular pressure and encapsulated blebs diagnosed at a maximum five months after primary trabeculectomy with mitomycin C were included. The eyes were randomized to either transconjunctival needling revision with 5- fluorouracil or medical treatment (hypotensive eyedrops). A maximum of two transconjunctival needling revisions per patient was allowed in the needling arm. All patients underwent follow-up for 12 months. Successful treatment was defined as an intraocular pressure ≤ 18 mmHg and a 20% reduction from baseline at the final follow-up. Clinicaltrial.gov: NCT01887223. RESULTS: Mean intraocular pressure at the final 12-month follow-up was lower in the transconjunctival needling revision group compared to the medical treatment group. Similar numbers of eyes reached the criteria for treatment success in both the transconjunctival needling revision group and the medical treatment group. CONCLUSIONS: Despite similar success rates in eyes randomized to transconjunctival needling revision with 5-fluorouracil compared to eyes receiving medical treatment, there was a significantly lower mean intraocular pressure at 12 months after transconjunctival needling revision

Correlation Between the Water Drinking Test and Modified Diurnal Tension Curve in Untreated Glaucomatous Eyes

OBJECTIVES: To investigate the correlation and agreement between the intraocular pressure peaks detected during the water drinking test and the modified diurnal tension curve in untreated glaucomatous eyes. INTRODUCTION: It has been suggested that the intraocular pressure peaks detected during the water drinking test predict the peaks observed during a 24-hour diurnal tension curve. A more feasible and practical test for assessing intraocular pressure peaks in glaucomatous eyes during office hours would be of great clinical utility. METHODS: This was a prospective study involving open angle glaucoma patients without anti-glaucoma medication submitted to the modified diurnal tension curve and water drinking test on the same day. The intraocular pressure peaks during the water drinking test and the modified diurnal tension curve were reported and compared. Statistical analysis was performed to assess the correlation and agreement between intraocular pressure peak measurements. RESULTS: The correlation between intraocular pressure peaks during the water drinking test and modified diurnal tension curve was significant and strong (Pearson's Correlation Coefficient r=0.780, p<0.0001). Limited agreement was observed between these measurements. Eighty-two percent of intraocular pressure peaks were higher during the water drinking test than the modified diurnal tension curve. DISCUSSION: These findings suggest that the water drinking test may be used as tool to assess risk factors for glaucomatous patients. CONCLUSION: Intraocular pressure peaks detected during the water drinking test could be used in clinical practice to both estimate the peaks observed during the modified diurnal tension curve and assess the status of the eye's outflow facility

Staging Glaucoma Patient: Why and How?

Staging glaucomatous damage into appropriatecategories enhances management of the disease. Automated static perimetry is the benchmark for testing visual function in glaucoma. Numerous examples of standard automated perimetry staging systems have been proposed but difficulties such as lack of accuracy, absence of information related to location and depth of the defect(s) and need of time-consuming analysis of every visual field test result may reduce their day-to-day clinical usefulness.A new visual field staging system is proposed: the University of São Paulo Glaucoma Visual Field Staging System (USP-GVFSS). In this system, qualitative and quantitative characteristics of the visual field defect are described. The method is intuitive, comprehensible and describes severity, extension and hemi field involvement

Twenty-four-hour repeatability of diurnal intraocular pressure patterns in glaucomatous and ocular hypertensive individuals

OBJECTIVE: To verify the 24-hour repeatability of diurnal intraocular pressure patterns in glaucomatous and ocular hypertensive individuals. METHODS: A prospective analysis of 88 eyes from 88 ocular hypertensive or open-angle glaucoma patients was conducted on diurnal tension curves obtained by the same examiner on two consecutive days. The intraclass correlation coefficient test was used for statistical analysis. RESULTS: Eighty-eight eyes from 88 patients were analyzed. Fifty-seven patients (64.8%) were female. The mean age of all participants was 68.7 (SD 10.8, range 51-79) years. The intraclass correlation coefficient values for measurements at 8 AM, 11 AM, 2 PM, and 4 PM were 0.80, 0.82, 0.83, and 0.86, respectively (all intraclass correlation coefficient values, p<0.001). CONCLUSION: Diurnal intraocular pressure data collected on a single day characterize the diurnal intraocular pressure variability over 24 hours in primary open-angle glaucoma and ocular hypertensive patients

Correlation between central corneal thickness and intraocular pressure peak and fluctuation during the water drinking test in glaucoma patients

OBJECTIVE: To investigate the correlation between central corneal thickness and outflow facility assessed by intraocular pressure peak and fluctuation during the water drinking test. METHODS: Fifty-five newly diagnosed primary open-angle glaucoma patients submitted to central corneal thickness measurements and water drinking test were enrolled in this retrospective study.;. Patients were divided into three groups according to their central corneal thickness. Pearson's Correlation test was performed in the groups with lower and higher pachymetric values. RESULTS: The mean age was 65,65 ± 28,28 years; 63,63% were female and 52,72% were caucasian. The mean central corneal thickness was 544,32 ± 36,86 µm, and the mean baseline intraocular pressure was 23,36 ± 6,26 mmHg. During the water drinking test, the mean intraocular pressure peak and mean intraocular pressure fluctuation were 30,43 ± 8,13 mmHg and 31,46 ± 18,46%, respectively. No relevant correlation was detected between the central corneal thickness and the intraocular pressure peak (r² = 0,021) or between the central corneal thickness and the intraocular pressure fluctuation (r² = 0,011). Group 1 presented a mean central corneal thickness of 505,81 ± 13,86 µm, and Group 3 was 583,55 ± 27,87 µm (p = 0,001). The mean intraocular pressure peak was 31,05 ± 9,05 mmHg and 27,83 ± 4,92 mmHg in Group 1 and in Group 3, respectively (p = 0,193). The difference of intraocular pressure fluctuation was not statistically significant between Group 1 (mean 28,47±16,25%) and Group3 (mean 33,27 ± 21,27%) (p = 0,43). CONCLUSION: In our case series, no correlation was found between central corneal thickness and water drinkingtest results

Tonometria de contorno dinâmico e tonometria de aplanação de goldman em olhos com ceratocone

PURPOSE: The dynamic contour tonometer is a nonapplanation contact tonometer designed to be largely independent of the structural properties of the cornea. Theoretically, it may measure intraocular pressure most accurately in abnormally thinner corneas. This study compares intraocular pressure measurements by dynamic contour tonometry with Goldman applanation tonometry in eyes with normal corneas and eyes with advanced keratoconus. METHODS: A comparative case series. Subjects underwent intraocular pressure measurements by dynamic contour tonometry, Goldman applanation tonometry, ultrasonic pachymetry, and slit scanning topography. Exclusion criteria: any ocular pathology other than keratoconus, previous corneal or refractive surgery, stromal scarring due to acute hydrops, or any other corneal opacities. RESULTS: Ten patients with keratoconus were included in Group A, and 12 normal patients composed Group B according to the pre-established criteria. The mean Goldman tonometry measurement in group A was 10.3 ± 1.8 mm Hg and group B was 14.3 ± 0.75 mm Hg. (P = 0.024). In group A, the mean measurement with the dynamic contour tonometer was 14.6 ± 2.09 mm Hg, and in group B, it was 17.4 ± 3.1 mm Hg (P = 0.026). The difference between both methods of measurement in group A was statistically significant (P < 0.0002). CONCLUSION: Intraocular pressure readings with dynamic contour tonometry in the keratoconus group were significantly higher than Goldman measurements and lower when compared to the control group. As there are no published manometric studies in eyes with keratoconus, these lower intra-ocular readings with the dynamic contour tonometry could be related to the discrepancy between the radius of corneal curvature and its tip, the significant thinning of the cornea, or other corneal biomechanical abnormalities related to advanced keratoconus.OBJETIVO: O tonômetro de contorno dinâmico é um aparelho de contato e não-aplanação projetado para ser independente das propriedades estruturais da córnea. Teoricamente, ele mede de forma mais precisa a pressão intra-ocular em córneas muito finas. Este estudo compara as medidas de pressão intra-ocular pelo tonômetro de contorno dinâmico com a tonometria de aplanação de Goldman em olhos normais e em olhos com ceratocone avançado. MÉTODOS: uma série comparativa de casos. Pacientes foram submetidos às medidas de pressão intra-ocular por ambos os métodos mencionados, paquimetria ultrassônica e topografia corneana de varredura. Critérios de exclusão: qualquer patologia ocular exceto ceratocone, cirurgia ceratorrefrativa prévia, opacidade estromal resultante de hidropsia aguda ou qualquer outra opacidade corneana. RESULTADOS: Dez pacientes com ceratocone foram incluídos no grupo A e 12 pacientes com córneas normais no grupo B conforme os critérios pré-estabelecidos. A média das medidas da tonometria de Goldman no grupo A foi de 10.3±1.8 mmHg e no grupo B de 14.3±0.75 mmHg. (p = 0,024). No grupo A, a média das medidas com o tonômetro de contorno dinâmico foi de 14.6±2,09 mmHg e, no grupo B,17,4±3,1 mmHg (p = 0,026). A diferença entre as medidas dos tonômetros no grupo A foi estatisticamente significante (p < 0.0002). CONCLUSÃO: As medidas da pressão intra-ocular com o tonômetro de contorno dinâmico nos pacientes com ceratocone foram significativamente maiores que as medidas do Goldman e menores quando comparadas com o grupo controle. Na ausência de estudos manométricos em olhos com ceratocone, estas baixas medidas com a tonometria de contorno dinâmico podem estar relacionadas com a discrepância entre o raio de curvatura da córnea e a ponta do tonômetro, os baixos valores paquimétricos, ou outras anormalidades da biomecânica corneana relacionadas com o ceratocone avançado

Pacientes com glaucoma e blefaroespasmo essencial: relato de casos

Essential blepharospasm is a facial dystonia characterized by spontaneous, spasmodic and involuntary contractions of the eyelid muscles. In advanced cases, blepharospasm patients develop severe eyelid spasms that render them functionally blind, socially reclusive, and unable to work or care for themselves. Oculoplastic surgeons frequently have to deal with patients with blepharospasm. The decrease in quality of life caused by this pathology drives all the attention to the resolution of the spasms. However, other conditions may be associated with them and must be kept in mind during the ophthalmological examination. Four patients with essential blepharospasm were diagnosed as glaucomatous during their follow-up at the Oculoplastic Service. All of them showed glaucomatous optic neuropathy and corresponding visual field defect and no clinically apparent secondary cause for their glaucoma. Forced eyelid closure may lead to intraocular pressure peaks. These patients with blepharospasm present repetitive and spasmodic eyelid contractions and the intraocular pressure rise observed during eyelid squeezing could be an additional risk factor for glaucomatous damage. Our case series suggest that patients with blepharospasm should be seriously evaluated for glaucoma.Blefaroespasmo essencial é uma distonia facial caracterizada por contrações espontâneas, espasmódicas e involuntárias dos músculos palpebrais, podendo tornar os pacientes funcionalmente cegos. Tais pacientes são geralmente referidos aos médicos oculoplásticos para avaliação e tratamento. Devido à intensidade dos espasmos e ao comprometimento da qualidade de vida, toda a atenção é dirigida à sua resolução e outras condições oculares associadas podem passar despercebidas. Neste estudo, quatro pacientes com blefaroespasmo foram diagnosticados como glaucomatosos durante o seu seguimento no Departamento de Plástica Ocular. As quatro pacientes apresentavam neuropatia óptica glaucomatosa e defeito no campo visual compatível, sem que houvesse nenhuma causa secundária para o glaucoma. O fechamento palpebral forçado causa importante aumento da pressão intra-ocular e estes pacientes com blefaroespasmo, por apresentar contrações espasmódicas e repetitivas das pálpebras, poderiam estar sob risco aumentado de desenvolver glaucoma

Vision for the Future Project: Screening impact on the prevention and treatment of visual impairments in public school children in São Paulo City, Brazil

OBJECTIVES: Uncorrected refractive errors are the leading cause of visual impairment in children. In this cross-sectional retrospective study, we analyzed a social visual screening program for school children in São Paulo, Brazil, evaluated its impact on the prevention and treatment of children's visual disabilities, and assessed its epidemiological outcomes to outline suggestions for its improvement. METHODS: First-grade children from public schools were submitted to prior visual screening by their teachers. Selected children were forwarded to the hospital's campaigns for a second screening by ophthalmologists and treatment if needed. Data were analyzed for age, sex, visual acuity, biomicroscopy, refractive errors, ocular movement disorders, amblyopia, number of donated spectacles, and number of children forwarded to specialized care. RESULTS: A total of 1080 children were included with mean age of 6.24±0.45 years. Children with normal ophthalmological exam, 591 (54.7%; 95% confidence interval [CI]: 51.7%-57.7%) were dismissed and considered false-positives. Myopia, hyperopia, and astigmatism components were found in 164 (15.2%; CI: 13.1%-17.4%), 190 (17.6%; CI: 15.3%-20.0%), and 330 (30.5%; CI: 27.8%-33.4%) children, respectively. Amblyopia was diagnosed in 54 (5%; CI: 3.5%-6.4%) children, and 117 (10.8%; CI: 9.8%-12.8%) presented ocular movement disorders. A total of 420 glasses were donated. CONCLUSION: Epidemiological findings for amblyopia and refractive errors are consistent with those of similar studies. The expressive number of diagnoses performed and number of glasses donated to underprivileged children depict the importance of such projects. New guidelines to improve their cost-effectiveness, such as professional training and community sensitization, are imperative