Remo Susanna

Purpose: To evaluate the reproducibility and intra-eye similarity of the intraocular pressure (IOP) peaks induced by the water drinking test (WDT) in treated glaucoma patients. Methods: This prospective cohort study evaluated 99 patients (198 eyes) who were treated for primary open-angle glaucoma. All patients underwent WDT in two consecutive visits with no change in their current therapy. The interval between the tests was 4 four to six months. The tests were administered at a similar time (4:00 PM ± 1 hour). The reproducibility of the time of the IOP peaks and the correlation between the peak time of both eyes during the two consecutive WDT sessions were assessed. Results: Of all IOP peaks, 59.6% and 71.7% occurred at the same time during the two WDT sessions in the right and left eyes, respectively. In the first and second WDT sessions, the agreements in IOP peak time between the right and left eyes were 60% and 63%, respectively. Conclusion: The IOP peak time between the two consecutive WDT sessions was moderately reproducible, and there was a moderate agreement in the peak time between the two eyes. In light of these findings, clinicians should avoid performing simplified versions of WDT to evaluate IOP peaks.

O rinoceronte cinzento é uma metáfora para as ameaças que podemos ver e reconhecer, mas contra as quais não fazemos nada. Por que, afinal, continuamos ignorando as ameaças mais óbvias? […] Por que as pessoas ainda ficam cegas pelo glaucoma. A metáfora do rinoceronte cinza O rinoceronte cinzento é uma metáfora para as ameaças que podemos ver e reconhecer, mas contra as quais não fazemos nada. Por que, afinal, continuamos ignorando as ameaças mais óbvias? […] Por que as pessoas ainda ficam cegas pelo glaucoma. A metáfora do rinoceronte cinza

AUMENTAR A EFICÁCIA A eficácia do implante depende principalmente da biocompatibilidade, do tamanho e das características do prato do implante. Vários trabalhos deixaram claro que implantes com área entre 200mm2 e 250mm2 são os ideais, uma vez que maiores que isso aumentavam as complicações sem aumentar a eficiência. Também uma inserção fácil, sem traumatizar os tecidos adjacentes, e um material sem irregularidades na superfície diminuem a inflamação e a fibrose que resultam no encapsulamento, principal causa de insucesso.(-) […] Implante [...] AUMENTAR A EFICÁCIA A eficácia do implante depende principalmente da biocompatibilidade, do tamanho e das características do prato do implante. Vários trabalhos deixaram claro que implantes com área entre 200mm2 e 250mm2 são os ideais, uma vez que maiores que isso aumentavam as complicações sem aumentar a eficiência. Também uma inserção fácil, sem traumatizar os tecidos adjacentes, e um material sem irregularidades na superfície diminuem a inflamação e a fibrose que resultam no encapsulamento, principal causa de insucesso.(-) […] Implante

Purpose: To investigate the association between the time of occurrence of intraocular pressure (IOP) peaks during the water-drinking test (WDT) and visual field damage in a cohort of primary open-angle glaucoma (POAG) patients. Methods: In this retrospective, cross-sectional study, 98 eyes from 49 consecutive POAG patients were followed in a referral clinical practice. The relationship between the time when IOP peaks occurred during the WDT and the visual field mean deviation (MD) assessed with 24-2 visual field was tested with mixed-effects models. Results: MD value was significantly associated with the time of IOP peak occurrence (P = 0.020) when adjusting for the number of medications, but not with the IOP peak values (P = 0.238). Conclusion: The time of IOP peaks occurrence during the WDT was associated with glaucoma severity among treated POAG patients.

Objective: The main aim of this study was to evaluate the performance of a platform designed for pediatricians to screen amblyopia using a smartphone. Methods: The medical records of consecutive children who received visual screening using a smartphone platform were retrospectively reviewed. The smartphone was used with a flash concentrator case and a software for capturing images of both eyes simultaneously by a photorefraction mechanism. The platform performance was compared to the comprehensive ophthalmological examination, which is considered the gold standard for detecting amblyopia. Sensitivity, specificity, positive predictive value, and negative predictive value of the software in detecting amblyopia risk factors were calculated. Results: A total of 157 children were included, with a mean age of 6.0±.5 years (range 5–7). In 94% of the cases, the software was able to analyze the images and release a result, determining whether or not the child presented with amblyopia risk factors. Compared to the ophthalmological examination, the smartphone platform sensitivity in detecting amblyopia risk factors was 84%, the specificity was 74%, the positive predictive value was 86%, and the negative predictive value was 70%. Conclusions: The sensitivity and specificity of the smartphone photoscreening platform to detect amblyopia risk factors were within the range of traditional instrument-based vision screening technology. A smartphone photorefraction platform appears to be a promising cost-effective alternative to assist pediatricians and minimize obstacles to vision screening and amblyopia detection. Future studies are needed to gather additional comparative data.

Precis: This study found a rate of failure of 13.6% of the new Susanna Glaucoma Drainage Device (SGDD) after 1 year of follow-up. Severe complications occurred in 1 patient (4.5%). Purpose: The purpose of this study was to determine the success and complications rates of the SGDD implant in refractory glaucoma. Patients and Methods: This is a retrospective study. Medical records from all consecutive refractory glaucoma patients (failed trabeculectomies with the use of adjunctive mitomycin) followed in a private clinical practice were included in the study. All patients had undergone SGDD implant surgery from September 2016 to July 2019 were included. All surgeries were done by the same surgeon (R.S.). Primary outcome was surgical failure, defined as intraocular pressure (IOP) >18 mm Hg and/or Pt test) at an average of 18±9 months after the tube implant. The mean SD number of glaucoma medications was reduced from 3.3±1 to 1.5±1.2 at the last postoperative visit (Pt test). No early postoperative complications occurred. There was 1 case of late persistent hypotony in a patient with previous endocyclophotocoagulation that was solved with tube ligature with silk 8-0. Failure because of high IOP occurred in 2 cases. There was no extrusion or erosion of the tube and the plate. Conclusion: The SGDD presented a 13.6% failure rate (86.4% success rate) with very few complications, being an efficient and safe alternative for refractory glaucoma.

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 ...