Analysis of neuroretinal rim distribution and vascular pattern in eyes with presumed large physiological cupping: a comparative study

Background: To investigate possible differences in neuroretinal rim distribution, vascular pattern, and peripapillary region appearance between eyes with presumed large physiological optic disc cupping (pLPC) and eyes with minimal optic disc excavation.Methods: We prospectively enrolled consecutive subjects with pLPC and individuals with minimal excavation (optic disc excavation within normal limits; control group). All eyes had normal visual fields and untreated intraocular pressure (IOP) = 0.6 and >= 30 months of follow-up with no evidence of glaucomatous neuropathy. for controls, VCDR was limited to <= 0.5. We compared ocular signs and characteristics related to the neuroretinal rim distribution, vascular pattern, peripapillary region appearance and disc size between groups. Whenever both eyes were eligible, one was randomly selected for analysis.Results: A total of 74 patients (mean age, 45.6 +/- 14.9 years) with pLPC and 45 controls (mean age, 44.8 +/- 11.6 years) were enrolled (p = 0.76). Median disc size and VCDR was significantly larger in eyes with pLPC compared to controls (p < 0.01). the proportion of eyes with violation of the ISNT rule, laminar dot sign, nasal shifting of the central vessels, nasal excavation and baring of circumlinear vessel was significantly greater in the eyes with pLPC compared to controls (p < 0.01). There were no significant differences regarding the proportions of eyes with peripapillary atrophy between groups (p < 0.09). Finally, disc size was significantly associated with VCDR (r(2) = 0.47, p < 0.01), with an increase of 0.21 in VCDR for each 1 mm(2) in disc area.Conclusion: Compared to normal controls, eyes with pLPC may present a higher proportion of optic nerve head findings frequently observed in glaucomatous eyes. This seems to be explained in part by the larger discs found in these eyes. We believe care should be taken while classifying them as glaucomatous or not based solely on these characteristics.Universidade Federal de São Paulo, Dept Ophthalmol, BR-04021001 São Paulo, BrazilHosp Med Olhos, Glaucoma Unit, BR-06018180 Osasco, SP, BrazilMayo Clin, Dept Ophthalmol, Jacksonville, FL 32224 USAUniversidade Federal de São Paulo, Dept Ophthalmol, BR-04021001 São Paulo, BrazilWeb of Scienc

Mecanismos de fechamento angular sem bloqueio pupilar: análise de prevalência e resultados terapêuticos

Purpose: To assess the prevalence and treatment outcomes of angle-closure mechanisms other than pupillary block in a population of Brazilian patients.Methods: A retrospective chart review was conducted to evaluate patients who had undergone laser peripheral iridotomy (LPI) due to occludable angles at a single institution between July 2009 and April 2012. An occludable angle was defined as an eye in which the posterior trabecular meshwork was not visible for >= 180 degrees on dark-room gonioscopy. Key exclusion criteria were any form of secondary glaucoma and the presence of >90 degrees of peripheral anterior synechiae. Collected data were age, race, gender, angle-closure mechanism (based on indentation goniocopy and ultrasound biomicroscopy), intraocular pressure (IOP), number of antiglaucoma medications and subsequent management during follow-up. If both eyes were eligible, the right eye was arbitrarily selected for analysis.Results: A total of 196 eyes of 196 consecutive patients (mean age 58.3 +/- 11.6 years) who underwent LPI were included. in most of the patients [86% (169 patients; 133 women and 36 men]), LPI sucessfully opened the angle. Mean IOP was reduced from 18.3 +/- 6.4 mmHg to 15.4 +/- 4.5 mmHg after LPI (p<0.01). Among the 27 patients with persistent occludable angles, the most common underlying mechanisms were plateau iris (56%) and lens-induced component (34%). Most of these patients (85%) were treated with argon laser peripheral iridoplasty (ALPI); approximately 90% showed non-occludable angles following the laser procedure (mean IOP reduction of 18.9%), with no significant differences between patients with plateau iris and lens-induced components (p=0.34; mean follow-up of 11.4 +/- 3.6 months).Conclusions: Our findings suggest that, in this population of Brazilian patients, several eyes with angle closure were not completely treated with LPI. in the present large case series involving middle-age patients, plateau iris was the leading cause of persistent angle closure and was effectively treated with ALPI. A detailed eye examination with indentation gonioscopy should always be performed after LPI to rule out persistent angle closure due to non-pupillary block mechanisms.Hosp Med Olhos, Glaucoma Unit, Osasco, SP, BrazilUniversidade Federal de São Paulo, São Paulo, BrazilMayo Clin, Jacksonville, FL 32224 USAUniversidade Federal de São Paulo, São Paulo, BrazilWeb of Scienc

Angle Closure Associated With a Cobblestone Iris Configuration: Clinical and Imaging Description

Purpose:The purpose of the study was to report a patient with primary angle closure associated with a different nonpupillary block mechanism in which an abnormally thick peripheral iris assumes a cross-sectional shape resembling a cobblestone.Methods:This is a case report focussing on clinical and imaging description.Results:Slit-lamp biomicroscopy revealed patent laser peripheral iridotomies OU. the anterior chamber was relatively deep in the center but 360 degrees narrow at the periphery, associated with an abnormally elevated iris contour OU. On dark-room gonioscopy, the angles were occludable with few areas of peripheral anterior synechiae. Anterior segment-adapted spectral domain-optical coherence tomography revealed an unusual iris profile. Despite a flat contour and normal thickness until the mid-periphery, the iris assumed a rectangular cross-sectional shape (resembling a cobblestone) with an abnormal increase in its thickness in the periphery (360 degrees OU). Ultrasound biomicroscopy imaging showed a normal ciliary sulcus and ciliary body configuration, revealing no cysts at 360 degrees. Definitive relief of appositional angle closure was achieved with laser peripheral iridoplasty OU.Conclusions:This unusual anatomic condition of the peripheral iris, which has different characteristics when compared with ordinary cases of thick peripheral iris roll, may lead to angle closure and intraocular pressure elevation despite a patent iridotomy. Clinicians should be aware of this anatomic condition whenever dealing with cases of angle closure.Universidade Federal de São Paulo, Glaucoma Serv, Dept Ophthalmol, São Paulo, BrazilHosp Med Olhos, Glaucoma Serv, São Paulo, BrazilMayo Clin, Dept Ophthalmol, Glaucoma Serv, Jacksonville, FL 32224 USAUniversidade Federal de São Paulo, Glaucoma Serv, Dept Ophthalmol, São Paulo, BrazilWeb of Scienc

Padrão de envolvimento das camadas retinianas internas na atrofia retinocoroidiana pigmentada paravenosa determinado pelo SD-OCT: relato de caso

Pigmented paravenous retinochoroidal atrophy is an ocular disease characterized by outer retina and choroidal atrophy often with overlying intraretinal bone spicule pigment deposition along the retinal veins. As a rare condition, there is scant information in the literature regarding the pattern of inner retinal layers involvement. We present a case of a 41-year-old white man initially referred for a glaucoma evaluation. Fundoscopy revealed patches of retinochoroidal atrophy and light pigmentation extending from the optic nerve head along the inferior-temporal retinal veins in both eyes. Using different spectral-domain optical coherence tomography (SD-OCT) protocols we identified a significant thinning of the inner retinal layers along the inferior-temporal veins, but with a lucid interval surrounding the optic nerve head. Standard automated perimetry revealed a superior absolute arcuate scotoma sparing the central fixation (good structure-functional correlation). This pattern of inner retinal layers involvement was not previously described. We believe SD-OCT added significantly to the anatomical description of this case. Physicians should consider these new anatomical findings and correlate them with functional status while assessing these patients.Hosp Med Olhos, Sao Paulo, BrazilWeb of Scienc

Corneal Viscoelasticity Differences Between Diabetic and Nondiabetic Glaucomatous Patients

Purpose: To investigate corneal viscoelasticity in primary open-angle glaucoma patients with and without diabetes mellitus, and to correlate corneal hysteresis (CH) with central corneal thickness (CCT).Methods: in this cross-sectional study, 44 primary open-angle glaucoma patients [19 with diabetes (34 eyes) and 25 without diabetes (40 eyes)] underwent a complete ophthalmic examination. Data collected by masked investigators included CH and CCT using the Ocular Response Analyzer. the mean of 3 measurements was considered for each test. We analyzed the difference between the mean CH in both groups using a general linear model. Partial correlation coefficient between CH and CCT was also calculated.Results: Mean +/- SD age in diabetic and nondiabetic groups was 67.1 +/- 8.7 and 65.9 +/- 15.1, respectively (P=0.77). There was no significant difference regarding mean CCT between diabetic (531.7 +/- 31.3 mm) and nondiabetic (546.6 +/- 37.3 mm) groups (P=0.21). Patients with diabetes presented significantly higher CH values than patients without diabetes (9.1 +/- 1.9 mm Hg vs. 7.8 +/- 1.7 mm Hg, P=0.04). There was a significant and positive correlation between CH and CCT for all patients (r=0.407, P<0.001).Conclusions: Primary open-angle glaucoma patients with diabetes have significantly higher CH values than those without diabetes. CH and CCT results were positively correlated. These findings merit further investigation to assess the role of different CH values on glaucoma evaluation and susceptibility.Universidade Federal de São Paulo, Dept Ophthalmol, São Paulo, BrazilTufts Univ, Sch Med, New England Eye Ctr, Tufts Med Ctr, Boston, MA 02111 USANew York Eye & Ear Infirm, Einhorn Clin Res Ctr, New York, NY 10003 USAUniversidade Federal de São Paulo, Dept Ophthalmol, São Paulo, BrazilWeb of Scienc

Selective laser trabeculoplasty for early glaucoma: analysis of success predictors and adjusted laser outcomes based on the untreated fellow eye

Background: To identify success predictors and to study the role of the fellow untreated eye as a co-variable for adjustment of intraocular pressure (IOP) outcomes following selective laser trabeculoplasty (SLT) in early open-angle glaucoma (OAG) patients. Methods: A case series was carried out. Patients with uncontrolled early OAG or ocular hypertension (inadequate IOP control requiring additional treatment) underwent SLT (one single laser session) performed by the same surgeon in a standardized fashion. The same preoperative medical regimen was maintained during follow-up for all patients. Post-treatment assessments were scheduled at week 1 and months 1, 2, and 3. In order to account for possible influence of IOP fluctuation on laser outcomes, post-laser IOP values of the treated eye of each patient were also analyzed adjusting for IOP changes (between visits variation) of the untreated fellow eye (adjusted analysis). Pre and post-laser IOP values were compared using paired t-test. Factors associated with the magnitude of IOP reduction were investigated using multiple regression analysis. Results: A total of 45 eyes of 45 patients were enrolled. Mean IOP was reduced from 20.8 +/- 5.1 to 14.9 +/- 2. 9 mmHg at month 3 (p = 20%) was 64% and mean percentage of IOP reduction was 23.1 +/- 14.3% at last follow-up visit. Considering unadjusted post-laser IOP values, it was found a 20% greater absolute IOP reduction (median [interquartile range] 6 mmHg [4-7] vs 5 mmHg [3-7]p = 0.04), with a success rate of 76%. Although baseline IOP was significantly associated with both adjusted and unadjusted post-laser IOP reduction, a stronger association was found when unadjusted IOP values were considered (p = 0.150). Conclusions: In this group of patients with early OAG or ocular hypertension, our short-term results confirmed SLT as a safe and effective alternative for IOP reduction. Although better outcomes were found in eyes with higher preoperative IOP, this effect was mitigated when results were adjusted to the fellow untreated eye (to the influence of between visits-IOP fluctuations).Univ Fed Sao Paulo, Dept Ophthalmol, Rua Botucatu 821, BR-04023062 Sao Paulo, SP, BrazilHosp Med Olhos, Glaucoma Unit, Osasco, SP, BrazilDepartment of Ophthalmology, Universidade Federal de São Paulo (UNIFESP), Rua Botucatu, 821. Vila Clementino, São Paulo, São Paulo, CEP: 04023-062, BrazilWeb of Scienc