Kanadani, Fábio Nishimura

Purpose To compare the outcomes of standard combined Phaco-Kahook Dual Blade (KDB) surgery (GI) with those of the extended technique (GII). Methods This retrospective, comparative, multicenter, case-control study enrolled patients with one-year follow-up. GI removed 90° of the trabecular meshwork (TM) extension during KDB, whereas GII removed 150°. The successful criteria were based on a modification of the AAO PPP recommendations - Reporting Clinical Endpoints in Studies of Minimally Invasive Glaucoma Surgery. Qualified success was achieved with or without medication, while absolute success was achieved without the use of any ocular hypotensive medication. Results A total of 72 eyes (36 in both groups) were included. The IOP was similar between groups preoperatively (GI: 17.0 ± 2.7 mmHg vs. GII: 17.5 ± 4.2 mmHg, p = 0.5), and at 12 months postoperatively (GI: 13.5 ± 2.8 mmHg vs. GII: 12.3 ± 2.7 mmHg, p = 0.06). The number of glaucoma medications was reduced from 1.7 ± 0.9 to 0.4 ± 0.8 in GI ( p < 0.001) and from 2.1 ± 0.8 to 0.4 ± 0.7 in GII ( p < 0.001). At 12 months, both groups reduced comparable glaucoma medications ( p = 0.9). Qualified success was achieved in 77.1% of the eyes with GI and 94.4% with GII ( p = 0.03), whereas complete success was achieved in 68.6% of the eyes with GI and 69.4% with GII ( p = 0.7). No serious complications were observed in any of the groups. Conclusion Extended combined Phaco-KDB surgery showed greater relative success than the Standard Phaco-KDB technique. Both techniques achieved similar IOP reduction at 12 months postoperatively.

Précis: Patients with clinically uncontrolled open angle glaucoma submitted to isolated gonioscopy-assisted transluminal trabeculotomy or combined with phacoemulsification not only achieved low mean IOPs, but also demonstrated stable IOP patterns during a 24-month follow-up. Purpose: To assess the impact of gonioscopy-assisted transluminal trabeculotomy (GATT) on long-term intraocular pressure (IOP) variation. Patients and Methods: An unicentric retrospective study including 169 consecutive patients who had undergone standalone GATT or combined with phacoemulsification (PHACOGATT) due to clinically uncontrolled open angle glaucoma, with at least 12 months of follow-up was conducted. Long-term mean IOP, long-term IOP peak, long-term IOP fluctuation, coefficient of variation, mean-positive IOP variation, sustained clinically significant positive IOP variation, and number of follow-up visits with IOP ≥15 mm Hg were investigated. Results: One hundred sixty-nine eyes from 169 patients were included (GATT group=101 patients; PHACOGATT group=68 patients). Mean long term IOP (12.0±1.8 vs. 11.2±2.0 mm Hg), mean long-term IOP peak (12.9±2.6 vs. 11.8±3.5 mm Hg), and mean coefficient of variation (0.07±0.08 vs. 0.05±0.09) were lower in the PHACOGATT group, while mean IOP fluctuation (1.0±3.7 vs. 1.2±1.8 mm Hg) was lower in the GATT group. In addition, the overall mean-positive IOP variation was 0.79±1.64 mm Hg. Finally, only 6.5% of the patients presented sustained clinically significant positive IOP variation and IOP was ≥15 mm Hg in 5.9% of the follow-up visits. Conclusions: Patients with clinically uncontrolled open angle glaucoma submitted to GATT or PHACOGATT achieved low mean IOPs and demonstrated stable IOP patterns. Our results provide additional evidence supporting GATT and PHACOGATT as viable options for the treatment of medically uncontrolled glaucoma patients requiring low and stable IOPs.

Précis: Automated optic nerve head hemoglobin measurements through change over time in the Globin Individual Pointer (GIP) index, provided by the Laguna ONhE software, can be useful to evaluate structural progression in glaucoma. Purpose: To assess the performance of automated optic nerve head hemoglobin measurements (ONH Hb) for detection of structural progression in glaucoma patients using event analysis. Patients and Methods: Treated glaucoma patients were included in this cross-sectional study. Two experienced examiners classified patients into progressors and non-progressors (controls) based on serial color retinographies (CR). Progressors were then subdivided in structural changes of the neuroretinal rim (NR) or retinal nerve fiber layer (RNFL). Globin individual pointer (GIP) index, derived from ONH Hb measurements, was calculated for each CR using the Laguna ONhE software. Differences in GIP values, ​​between baseline and last visit CRs, were used to assess structural progression. Sensitivity at a fixed specificity (50%; median GIP difference in controls) and areas under receiver operating characteristic curves (AUROC) were calculated. Results: Eight-seven eyes (35 progressors and 52 controls) from 64 patients were enrolled. Mean GIP reduction over time was greater in progressors (−13.0±18.6) than controls (−2.9±10.4; P=0.001). In progressors, mean GIP reduction was greater in patients with NR changes (−19.6±19.5) than RNFL changes (−3.1±12.1; P=0.008). GIP difference correctly identified 69% of the progressors (AUROC: 0.66), being 76% of these progressions related to NR changes (AUROC: 0.76) and 57% to RNFL changes (AUROC: 0.52). Conclusions: The GIP index, based on automated ONH Hb measurements demonstrated good sensitivity to differentiate progressors from controls, especially in cases in which progression was documented through structural NR changes. Using only 2 CRs and event analysis, GIP changes over time can be a useful screening tool to evaluate structural progression.

SUMMARY OBJECTIVES To bring summarized information about what has been published so far regarding Covid-19, facilitating the access to information and a better understanding of this pandemic, and to contribute to the medical community in the decision-making against this virus. METHODS This review article brings collected information from different articles published since the beginning of the pandemic of the 2019 novel coronavirus. KEY RESULTS This paper aggregates and consolidates some epidemiological parameters and clinical knowledge about the novel coronavirus and brings what is new in the search for pandemic control. MAJOR CONCLUSIONS Governments and health authorities are under increased pressure to control the COVID-19 spreading. In this scenario, the scientific community is working hard to produce relevant papers which will help in the next steps against coronavirus. Our review summarized the latest news about SARS-CoV2, evidencing what we know about COVID-19 until now.

Purpose: To compare provocative test-based and long-term intraocular pressure variation parameters in patients with stable open-angle glaucoma. Methods: A prospective observational study was carried out in which stable open-angle glaucoma patients (⩾3 years of follow-up without any changes on current medical regimen) were consecutively enrolled. All patients were submitted to a water-drinking test. Long-term intraocular pressure parameters were obtained from isolated intraocular pressure measurements from each visit (⩾5 visits). We investigated the correlation and agreement between the following water-drinking test and long-term intraocular pressure parameters: mean, peak, and fluctuation. In addition, the percentage of eyes with significant intraocular pressure peaks during the water-drinking test (defined as a difference ⩾25% between water-drinking test intraocular pressure peak and mean long-term intraocular pressure) was assessed. Results: Sixty-three eyes from 63 open-angle glaucoma patients (mean age, 60.7 ± 11.8 years) were included. Mean and water-drinking test intraocular pressure peak correlated significantly with mean ( r = 0.67) and maximum long-term intraocular pressure ( r = 0.52), respectively ( p < 0.01). The correlation between water-drinking test intraocular pressure fluctuation and long-term intraocular pressure fluctuation was not significant ( p = 0.45). Limits of agreement from Bland–Altman plots exceeded the maximum allowed difference between methods (3 mm Hg) for all the intraocular pressure parameters analyzed, suggesting poor agreement between water-drinking test–derived and long-term intraocular pressure values. Overall, significant water-drinking test intraocular pressure peaks were observed in 39.7% of these eyes with stable open-angle glaucoma. Conclusion: Although some water-drinking test–based and long-term intraocular pressure parameters correlate significantly, water-drinking test results may not reflect the long-term intraocular pressure profile of stable open-angle glaucoma patients, as their agreement is poor. Many of these patients may experience significant water-drinking test intraocular pressure peaks, despite long-standing stable disease and unchanged medical regimen.

Purpose. To evaluate factors associated with midterm visual field (VF) variability in stable glaucoma patients in Brazil.Methods. This retrospective observational study included 59 eyes of 39 stable glaucoma patients. Baseline data assessed were age, gender, educational level, intraocular pressure (IOP), central corneal thickness, best-corrected visual acuity, spherical equivalent, number of hypotensive eye drops, type of glaucoma, number of VFs performed, follow-up in years, lens status, visual field index (VFI) values from the last 5 VF (standard automated perimetry (SAP)) tests, the presence or absence of central scotoma in the VF test, and the level of glaucomatous damage according to the VF mean deviation (MD) index of the last VFs. The 5 latest VFI scores were used to calculate the mean, the standard deviation (SD), and the coefficient of variation (CV). We divided the eyes into 2 groups, being group 1 comprised by the 29 eyes presenting the lowest CV values and group 2 comprised by the 30 eyes presenting the highest CV values. GEE models were used to compare the CV and demographic and clinical parameters of all participants.Results. Mean age of all subjects was 65.8 ± 10.1 years. 54.0% were women. Average SAP MD values for groups 1 and 2 were −2.8 ± 3.1 dB and −6.2 ± 4.1 dB, respectively (P=0.006). Average SAP VFI values for groups 1 and 2 were 95.6 ± 5.9% and 85.9 ± 11.3%, respectively (P=0.002). There was a statistically significant association between CV and SAP MD values (P=0.006). A worse SAP MD and VFI were associated with a higher CV. In addition, even adjusting for potential confounding factors (age and level of education), the association between CV and the SAP MD and between CV and VFI remained significant (P≤0.010).Conclusion. Glaucomatous patients with worse VF sensitivity scores (both MD and VFI indices) present higher VF test variability.