O PAPEL DO DOCENTE NA UNIVERSIDADE

A docência universitária é o produto final de um longo e custoso processo formativo, que somente se concretiza, quando o docente se apercebe da necessidade e exerce intensa atividade de multiplicador cultural. Tal atividade exige um grau de conscientização, nem sempre adquirido após uma profícua produção científica. Este artigo visa discutir um tripé, no centro do qual deve se posicionar o docente pertencente à Universidade: o ensino, a prestação de serviços à comunidade e a pesquisa. Enfatiza-se a inter-relação entre os três componentes, assim como a necessidade de uma dedicação harmoniosa do docente a cada elemento da tríade.The professorship at a University is the final product of a long and costly formative process that only ends when the professor realizes the necessity of exercising the activity of a cultural multiplier. This activity requires a level of consciousness not always acquired after an extensive scientific production. This article aims to discuss a triad, in the center of which the professor needs to position him(her)self: teaching, community work, and research. The author emphasizes the relationship between theses three components, as well as the necessity of a balanced dedication of the professor to each element of this triad

The Need For Artificial Tears In Glaucoma Patients: A Comparative, Retrospective Study.

To evaluate the need for artificial tears by glaucoma patients under topical hypotensive treatment and to identify risk factors associated with it. 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. Significantly more glaucoma patients (n=92; 52.6%) used artificial tears compared to age-matched controls (n=31; 17.7%) (p2 (OR=1.92), and duration of treatment >5 years (OR=2.93) were risk factors for the use of artificial tears (p<0.05). 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.766-

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

Avaliação prospectiva do laser de diodo micropulsado em pacientes com glaucoma refratário: resultados de um ano de seguimento

To evaluate the effectiveness in intraocular pressure reduction and safety of micropulse transscleral diode cyclophotocoagulation in refractory glaucoma. Methods: We prospectively evaluated a case series of 21 eyes of 21 consecutive patients with refractory glaucoma treated with micropulse transscleral diode cyclophotocoagulation at 12-month follow-up. The total treatment time was at the discretion of the surgeon, considering baseline and target intraocular pressure and glaucoma diagnosis. Intraocular pressure, inflammation, visual acuity, and number of medications were monitored. Success was defined as intraocular pressure between 6 and 21 mmHg and/or 30% reduction from baseline intraocular pressure with or without the use of antiglaucoma medications. Visual acuity loss was defined as a loss of >= 2 lines of vision on the Snellen chart or a >= 2-level decrease in visual function in patients with nonmeasurable chart acuity. Results: The mean age was 61.04 +/- 12.99 years, and 11 (52.4%) patients were male, with most (95%) patients showing low visual acuity at baseline (count fingers or worse). The mean intraocular pressure was 33.38 +/- 15.95 mmHg, and the mean number of medications was 3.5 +/- 1.1 at baseline. After 1, 3, 6, and 12 months, 76.19%, 57.14%, 55.56%, and 66.67%, respectively, of the patients were classified as treatment successes. Seven (33.3%) patients required new laser treatment and were considered treatment failures. The mean intraocular pressure reduction was 44.72% +/- 29.72% in the first week and 41.59% +/- 18.93% at the end of follow-up (p=0.006). The mean number of medications significantly dropped to 2.00 +/- 1.7 at the 12-month visit (p=0.044). Complications included hypotony (4.8%), intraocular inflammation after 1 month (19%), and visual acuity loss (4.8%). Conclusions: Micropulse transscleral diode cyclophotocoagulation was safe and effective for reducing intraocular pressure in eyes with refractory and advanced glaucoma, with reduced need for ocular antihypertensive medication825381388Avaliar a eficácia na redução da pressão intraocular e na segurança da ciclofotocoagulação com laser de diodo transescleral em glaucoma refratário. Métodos: Avaliamos prospectivamente uma série de casos de 21 olhos de 21 pacientes com glaucoma refratário tratados com ciclofotocoagulação com laser de diodo transescleral com acompanhamento por 12 meses. O tempo total de tratamento ficou a critério do cirurgião, considerando a pressão intraocular inicial e alvo e o tipo de glaucoma. Pressão intraocular, inflamação, acuidade visual e número de medicamentos foram monitorados. O sucesso foi definido como pressão intraocular entre 6 e 21 mmHg e/ou redução de 30% da pressão intraocular basal com ou sem o uso de medicamentos glaucomatosos. Perda da acuidade visual foi definida como perda de ≥2 linhas de visão na tabela de Snellen ou uma diminuição de ≥ 2 níveis na função visual em pacientes com acuidade do gráfico não mensurável. Resultados: A idade média foi de 61,04 ± 12,99 anos e 11 (52,4%) pacientes eram do sexo masculino, com a maioria (95%) dos pacientes apresentando baixa acuidade visual inicialmente (conta dedos ou pior). A pressão intraocular média foi de 33,38 ± 15,95 mmHg, e o número médio de medicamentos foi de 3,5 ± 1,1, no início do estudo. Após 1, 3, 6 e 12 meses, 76,19%, 57,14%, 55,56% e 66,67%, respectivamente, dos pacientes foram classificados como sucesso do tratamento. Sete (33,3%) pacientes necessitaram de novo tratamento com laser e foram considerados falhas no tratamento. A redução média da pressão intraocular foi de 44,72% ± 29,72% na primeira semana e 41,59% ± 18,93% no final do seguimento (p=0,006). O número médio de medicamentos diminuiu significativamente para 2,00 ± 1,7 na visita de 12 meses (p=0,044). As complicações incluíram hipotonia (4,8%), inflamação intraocular após 1 mês (19%) e perda de acuidade visual (4,8%). Conclusões: A ciclofotocoagulação com laser de diodo transescleral foi segura e eficaz para reduzir a pressão intraocular em olhos com glaucoma refratário e avançado, com necessidade reduzida de hipotensores oculare

Correlation between the topographic scanning system (TOPSS) and visual field indices

PURPOSE: To evaluate the correlation between the parameters derived from the topographic scanning system (TOPSS) and visual field indices. METHODS: One-hundred and twelve primary open-angle glaucoma patients and 88 normal controls were enrolled in the study. All individuals underwent a thorough ophthalmic examination, including visual field (Humphrey 24-2, Full Threshold mode), evaluating Mean Deviation (MD) and correct pattern standard deviation (CPSD) and TOPSS (average disc diameter, total disc area, cup area, cup shape, cup volume, average cup depth, average disc depth, neuroretinal rim (NRR) volume, NRR area, cup/disc area ratio, horizontal cup/disc ratio e vertical cup/disc ratio). The comparison between groups was done using the Mann-Whitney Test or the independent Student's t test. The correlation between the visual field indices and TOPSS parameters was performed with the Spearman's correlation. RESULTS: The TOPSS parameters with better correlation were: cup area (MD: r= -0.538, p<0.001; CPSD: r= 0.512, p<0.001), vertical C/D ratio (MD: r= -0.506, p<0.001; CPSD: r= 0.483, p<0.001) e cup/disc area ratio (MD: r= -0.458, p<0.001; CPSD: r= 0.453, p<0.001). However, there was considerable variability between groups with different levels of visual field loss. CONCLUSIONS: The TOPSS variables presented, in general, substantial correlation with visual field indices. Although some of these parameters showed highly significant correlations, considerable variability of the structural parameters for the same level of functional damage may limit the usefulness of TOPSS isolated parameters in the diagnosis of glaucoma.OBJETIVOS: Avaliar a correlação entre os parâmetros do Topógrafo de Disco Óptico (TOPSS) e índices da perimetria computadorizada. MÉTODOS: Cento e doze pacientes com glaucoma primário de ângulo aberto e 88 indivíduos normais foram incluídos no estudo. Todos os indivíduos foram submetidos ao exame oftalmológico completo, perimetria computadorizada (Humphrey 24-2, Full Threshold), avaliando-se Mean Deviation (MD) e Correct Pattern Standard Deviation (CPSD) e exame com TOPSS (average disc diameter, total disc area, cup area, cup shape, cup volume, average cup depth, average disc depth, neuroretinal rim (NRR) volume, NRR area, cup/disc area ratio, horizontal cup/disc ratio e vertical cup/disc ratio). A comparação entre os grupos foi realizada utilizando-se o Teste U de Mann-Whitney ou o Teste T de Student Independente. A correlação entre cada parâmetro do TOPSS e os índices do campo visual foi verificada utilizando-se a correlação de Spearman. RESULTADOS: Os parâmetros do TOPSS que apresentaram as correlações mais significativas com os índices de campo visual foram: Cup Area (MD: r = -0,538, p<0,001; CPSD: r =0,512, p<0,001), Vertical C/D Ratio (MD: r = -0,506, p<0,001; CPSD: r = 0,483, p<0,001) e Cup/Disc Area Ratio (MD: r = -0,458, p<0,001; CPSD: r = 0,453, p<0,001). Entretanto, houve importante variabilidade desses parâmetros em diferentes níveis de dano glaucomatoso, representados pelo MD e CPSD. CONCLUSÃO: As variáveis do TOPSS apresentam, no geral, correlação satisfatória com os índices do campo visual. Apesar de alguns desses parâmetros apresentarem correlação altamente significativa, existe grande variabilidade dos parâmetros estruturais para um mesmo nível de dano funcional, limitando a utilização isolada de parâmetros estruturais derivados do TOPSS no diagnóstico do glaucoma.737

Efficacy and safety of travoprost 0.004%/timolol 0.5% fixed combination as transition therapy in patients previously on prostaglandin analog monotherapy

Vital Paulino Costa1, Hamilton Moreira2, Mauricio Della Paolera3, Maria Rosa Bet de Moraes Silva41Universidade Estadual de Campinas &amp;ndash; UNICAMP, S&amp;atilde;o Paulo, 2Universidade Federal do Paran&amp;aacute;, Curitiba, 3Santa Casa de Miseric&amp;oacute;rdia de S&amp;atilde;o Paulo, S&amp;atilde;o Paulo, 4Faculdade de Medicina de Botucatu, UNESP, BrazilPurpose: To assess the safety and efficacy of transitioning patients whose intraocular pressure (IOP) had been insufficiently controlled on prostaglandin analog (PGA) monotherapy to treatment with travoprost 0.004%/timolol 0.5% fixed combination with benzalkonium chloride (TTFC).Methods: This prospective, multicenter, open-label, historical controlled, single-arm study transitioned patients who had primary open-angle glaucoma, pigment dispersion glaucoma, or ocular hypertension and who required further IOP reduction from PGA monotherapy to once-daily treatment with TTFC for 12 weeks. IOP and safety (adverse events, corrected distance visual acuity, and slit-lamp biomicroscopy) were assessed at baseline, week 4, and week 12. A solicited ocular symptom survey was administered at baseline and at week 12. Patients and investigators reported their medication preference at week 12.Results: Of 65 patients enrolled, 43 had received prior travoprost therapy and 22 had received prior nontravoprost therapy (n = 18, bimatoprost; n = 4, latanoprost). In the total population, mean IOP was significantly reduced from baseline (P = 0.000009), showing a 16.8% reduction after 12 weeks of TTFC therapy. In the study subgroups, mean IOP was significantly reduced from baseline to week 12 (P = 0.0001) in the prior travoprost cohort (19.0% reduction) and in the prior nontravoprost cohort (13.1% reduction). Seven mild, ocular, treatment-related adverse events were reported. Of the ten ocular symptom questions, eight had numerically lower percentages with TTFC compared with prior PGA monotherapy and two had numerically higher percentages with TTFC (dry eye symptoms and ocular stinging/burning). At week 12, TTFC was preferred over prior therapy for 84.2% of patients (48 of 57) by the patients themselves, and for 94.7% of patients (54 of 57) by their physicians.Conclusion: When TTFC replaced PGA monotherapy in patients whose IOP had been uncontrolled, the outcome was a significant reduction in IOP and an acceptable safety and tolerability profile. Most patients and investigators preferred TTFC to prior PGA monotherapy.Keywords: fixed combination, glaucoma, intraocular pressure, prostaglandin analog, timolol, travopros

Patient education in glaucoma: what do patients know about glaucoma?

PURPOSE: To evaluate the knowledge glaucoma patients have about their disease and its treatment. METHODS: One hundred and eighty-three patients were interviewed at the Glaucoma Service of Wills Eye Hospital (Philadelphia, USA, Group 1) and 100 at the Glaucoma Service of University of Campinas (Campinas, Brazil, Group 2). An informal, relaxed atmosphere was created by the interviewer before asking a list of 18 open-ended questions. RESULTS: In Group 1, 44% of the 183 patients did not have an acceptable idea about what glaucoma is, 30% did not know the purpose of the medications they were taking, 47% were not aware of what was an average intraocular pressure, and 45% did not understand why visual fields were examined. In Group 2, 54% gave unsatisfactory answers to the question What is glaucoma? , 54% did not know the purpose of the medications they were taking, 80% were not aware of what was an average intraocular pressure, and 94% did not understand why visual fields were examined (p\u3c0.001). Linear regression analysis demonstrated that level of education was positively correlated to knowledge about glaucoma in both groups (r=0.65, p=0.001). CONCLUSION: This study showed that patients\u27 knowledge about glaucoma varies greatly, and that in an urban, American setting, around one third of the patients have minimal understanding, whereas in an urban setting in Brazil around two thirds of patients were lacking basic information about glaucoma. Innovative and effective methods are needed to correct this situation

Patient Education In Glaucoma: What Do Patients Know About Glaucoma?

To evaluate the knowledge glaucoma patients have about their disease and its treatment. One hundred and eighty-three patients were interviewed at the Glaucoma Service of Wills Eye Hospital (Philadelphia, USA, Group 1) and 100 at the Glaucoma Service of University of Campinas (Campinas, Brazil, Group 2). An informal, relaxed atmosphere was created by the interviewer before asking a list of 18 open-ended questions. In Group 1, 44% of the 183 patients did not have an acceptable idea about what glaucoma is, 30% did not know the purpose of the medications they were taking, 47% were not aware of what was an average intraocular pressure, and 45% did not understand why visual fields were examined. In Group 2, 54% gave unsatisfactory answers to the question What is glaucoma?, 54% did not know the purpose of the medications they were taking, 80% were not aware of what was an average intraocular pressure, and 94% did not understand why visual fields were examined (p<0.001). Linear regression analysis demonstrated that level of education was positively correlated to knowledge about glaucoma in both groups (r=0.65, p=0.001). This study showed that patients' knowledge about glaucoma varies greatly, and that in an urban, American setting, around one third of the patients have minimal understanding, whereas in an urban setting in Brazil around two thirds of patients were lacking basic information about glaucoma. Innovative and effective methods are needed to correct this situation.69923-

[the Influence Of Intraocular Pressure Reduction With Medication On Retinal Nerve Fiber Layer Thickness Measurements Obtained With Scanning Laser Polarimetry In Glaucomatous And Hypertensive Eyes].

To evaluate changes in retinal nerve fiber layer thickness as measured by scanning laser polarimetry (SLP) after the use of medication to reduce intraocular pressure (IOP) in glaucomatous or ocular hypertensive patients. The authors prospectively enrolled 37 eyes of 37 patients in whom IOP was reduced by more than 25% after the use of medication. The images were obtained before and 15 to 30 days after the introduction of medication. The SLP parameters measured before and after the use of medication were compared using paired Student's t Test. The mean IOP was significantly reduced from 26.57 +/- 4.23 mmHg to 16.54 +/- 2.92 mmHg after the use of medication (p 0.05). The retinal nerve fiber layer thickness, as measured by SLP, is not affected by the reduction of IOP with medication in patients with glaucoma or ocular hypertension.69655-