{"id":291,"date":"2015-01-23T12:07:29","date_gmt":"2015-01-23T14:07:29","guid":{"rendered":"http:\/\/www.planetaw.com.br\/temp\/sbg\/?p=291"},"modified":"2019-06-24T15:41:15","modified_gmt":"2019-06-24T18:41:15","slug":"histerese-corneana-e-progressao-do-glaucoma-estudo-prospectivo","status":"publish","type":"post","link":"https:\/\/www.sbglaucoma.org.br\/medico\/histerese-corneana-e-progressao-do-glaucoma-estudo-prospectivo\/","title":{"rendered":"HISTERESE CORNEANA E PROGRESS\u00c3O DO GLAUCOMA: ESTUDO PROSPECTIVO – “SUA ATEN\u00c7\u00c3O ESPECIAL PARA”"},"content":{"rendered":"
\n
\"Jayme-Vianna\"Comentarios de Jayme A. R. Vianna sobre:<\/strong>
\nRef.: Corneal hysteresis as a risk factor for glaucoma progression: a prospective longitudinal study<\/strong>.
\nMedeiros FA, Meira-Freitas D, Lisboa R, Kuang TM, Zangwill LM, Weinreb RN.
\nOphthalmology. 2013 Aug;120(8):1533-40<\/strong>.<\/span><\/div>\n
\"\"Editor Associado<\/strong>
\n Luciana Alencar<\/strong><\/span><\/div>\n<\/div>\n

A grande variabilidade na resposta ao tratamento e na velocidade de progress\u00e3o sugere que existem outros fatores associados ao dano glaucomatoso al\u00e9m da press\u00e3o intraocular (PIO). A identifica\u00e7\u00e3o de fatores de risco associados a progress\u00e3o possui grande import\u00e2ncia tanto no acompanhamento de um paciente quanto na distribui\u00e7\u00e3o de recursos p\u00fablicos para sa\u00fade. Muito tem sido estudado a respeito do papel da histerese corneana nesse contexto. \u00c9 poss\u00edvel que varia\u00e7\u00f5es na histerese corneana falseiem as medidas de PIO obtidas com a tonometria de aplana\u00e7\u00e3o de Goldmann. Por outro lado \u00e9 tamb\u00e9m poss\u00edvel que olhos com maior resist\u00eancia corneana apresentem tamb\u00e9m maior resist\u00eancia na esclera peripapilar posterior e l\u00e2mina cribiforme, e assim maior resist\u00eancia aos efeitos da press\u00e3o intraocular<\/span>.<\/p>\n

O estudo de Medeiros et al. foi o primeiro com desenho longitudinal a estudar a associa\u00e7\u00e3o entre histerese corneana e progress\u00e3o do glaucoma. Nesse estudo, 114 olhos de 68 pacientes com glaucoma foram seguidos com exames regulares por uma m\u00e9dia de 4 anos. A medida da histerese corneana foi realizada no inicio do seguimento, com o aparelho Ocular Response Analyzer (Reichert). O aparelho usa um jato de ar para analisar a for\u00e7a necess\u00e1ria para deformar a c\u00f3rnea e seu retorno \u00e0 posi\u00e7\u00e3o original. C\u00f3rneas com valores de histerese mais baixos seriam mais male\u00e1veis. Os autores observaram que quanto mais baixa a histerese corneana, mais r\u00e1pida a piora do campo visual medida atrav\u00e9s do visual field \u00edndex (VFI)“C\u00f3rneas com valores de histerese mais baixos seriam mais male\u00e1veis. Os autores observaram que quanto mais baixa a histerese corneana, mais r\u00e1pida a piora do campo visual medida atrav\u00e9s do visual field \u00edndex (VFI)”<\/span> (a cada redu\u00e7\u00e3o de 1mmHg na histerese corneana resulta numa progress\u00e3o do VFI 0,25%\/ano mais r\u00e1pida). Essa associa\u00e7\u00e3o manteve-se mesmo com a an\u00e1lise multivariavel, ajustada para compensar outros fatores associados a progress\u00e3o do glaucoma. Al\u00e9m disso, foi observado que olhos com PIO elevada e histerese corneana baixa estao sob risco de progress\u00e3o mais r\u00e1pida.<\/p>\n

Os autores ressaltam que mais estudos s\u00e3o necess\u00e1rios para validar o papel da histerese corneana como fator de risco independente e para avaliar seu poder preditivo, mas pelos resultados encontrados \u00e9 poss\u00edvel sugerir que valores mais baixos de histerese corneana estejam relacionados a progress\u00e3o campimetrica de pacientes com glaucoma. Apesar de nao estar dispon\u00edvel na pratica clinica da maioria dos oftalmologistas, a medida de histerese corneana pode representar uma nova e \u00fatil informa\u00e7\u00e3o para identificar pacientes sob risco de apresentar uma progress\u00e3o glaucomatosa mais rapida.<\/p>\n

\n
\n

Resumo deste artigo<\/h3>\n
\n
\n
\n

Ophthalmology<\/em>. 2013 Aug;120(8):1533-40. doi: 10.1016\/j.ophtha.2013.01.032. Epub 2013 May 1.
\nCorneal hysteresis as a risk factor for glaucoma progression: a prospective longitudinal study.<\/strong>
\nMedeiros FA, Meira-Freitas D, Lisboa R, Kuang TM, Zangwill LM, Weinreb RN.
\nAuthor information<\/p>\n

Abstract<\/strong><\/p>\n

PURPOSE:<\/strong>
\nTo evaluate the role of corneal hysteresis (CH) as a risk factor for the rate of visual field progression in a cohort of patients with glaucoma followed prospectively over time.<\/p>\n

DESIGN:<\/strong>
\nProspective observational cohort study.<\/p>\n

PARTICIPANTS:<\/strong>
\nThe study group included 114 eyes of 68 patients with glaucoma followed for an average of 4.0 \u00b1 1.1 years. Visual fields were obtained with standard automated perimetry. Included eyes had a median number of 7 (range, 5-12) tests during follow-up.<\/p>\n

METHODS:<\/strong>
\nThe CH measurements were acquired at baseline using the Ocular Response Analyzer (Reichert Instruments, Depew, NY). Evaluation of rates of visual field change during follow-up was performed using the visual field index (VFI). Linear mixed models were used to investigate the relationship between rates of visual field loss and baseline CH, baseline intraocular pressure (IOP), and central corneal thickness (CCT), while adjusting for potentially confounding factors. An interaction term between IOP and CH was included in the model to investigate whether the effect of IOP on rates of progression depended on the level of CH.<\/p>\n

MAIN OUTCOME MEASURES:<\/strong>
\nEffects of CH, IOP, and CCT on rates of VFI loss over time.<\/p>\n

RESULTS:<\/strong>
\nThe CH had a significant effect on rates of visual field progression over time. In the univariable model including only CH as a predictive factor along with time and their interaction, each 1 mmHg lower CH was associated with a 0.25%\/year faster rate of VFI decline over time (P<0.001). The multivariable model showed that the effect of IOP on rates of progression depended on CH. Eyes with high IOP and low CH were at increased risk for having fast rates of disease progression. The CH explained a larger proportion of the variation in slopes of VFI change than CCT (17.4% vs. 5.2%, respectively).<\/p>\n

CONCLUSIONS:<\/strong>
\nThe CH measurements were significantly associated with risk of glaucoma progression. Eyes with lower CH had faster rates of visual field loss than those with higher CH. The prospective longitudinal design of this study supports the role of CH as an important factor to be considered in the assessment of the risk of progression in patients with glaucoma.<\/p>\n

FINANCIAL DISCLOSURE(S):<\/strong>
\nProprietary or commercial disclosure may be found after the references.<\/p>\n

Copyright \u00a9 2013 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.
\nPMID: 23642371 [PubMed – indexed for MEDLINE] PMCID: PMC3804228 [Available on 2014\/8\/1]<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"

Comentarios de Jayme A. R. Vianna sobre: Ref.: Corneal hysteresis as a risk factor for glaucoma progression: a prospective longitudinal study. Medeiros FA, Meira-Freitas D, Lisboa R, Kuang TM, Zangwill LM, Weinreb RN. Ophthalmology. 2013 Aug;120(8):1533-40. Editor Associado Luciana Alencar A grande variabilidade na resposta ao tratamento e na velocidade de progress\u00e3o sugere que existem […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"_joinchat":[],"footnotes":""},"categories":[1],"tags":[],"class_list":["post-291","post","type-post","status-publish","format-standard","hentry","category-sem-categoria"],"acf":[],"yoast_head":"\nHISTERESE CORNEANA E PROGRESS\u00c3O DO GLAUCOMA: ESTUDO PROSPECTIVO - "SUA ATEN\u00c7\u00c3O ESPECIAL PARA" - SBG - Sociedade Brasileira de Glaucoma<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.sbglaucoma.org.br\/medico\/histerese-corneana-e-progressao-do-glaucoma-estudo-prospectivo\/\" \/>\n<meta property=\"og:locale\" content=\"pt_BR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"HISTERESE CORNEANA E PROGRESS\u00c3O DO GLAUCOMA: ESTUDO PROSPECTIVO - "SUA ATEN\u00c7\u00c3O ESPECIAL PARA" - SBG - Sociedade Brasileira de Glaucoma\" \/>\n<meta property=\"og:description\" content=\"Comentarios de Jayme A. R. Vianna sobre: Ref.: Corneal hysteresis as a risk factor for glaucoma progression: a prospective longitudinal study. Medeiros FA, Meira-Freitas D, Lisboa R, Kuang TM, Zangwill LM, Weinreb RN. Ophthalmology. 2013 Aug;120(8):1533-40. 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