{"id":2960,"date":"2015-09-14T13:06:39","date_gmt":"2015-09-14T13:06:39","guid":{"rendered":"https:\/\/sbglaucoma2.websiteseguro.com\/medico\/?p=2960"},"modified":"2019-06-21T14:40:39","modified_gmt":"2019-06-21T17:40:39","slug":"campo-visual-vs-cirurgia","status":"publish","type":"post","link":"https:\/\/www.sbglaucoma.org.br\/medico\/campo-visual-vs-cirurgia\/","title":{"rendered":"Melhora do Campo Visual pos-Trabeculectomia?"},"content":{"rendered":"
\n
\"FOTO<\/a>Comentarios por Fabio Kanadani sobre:<\/strong>:<\/span><\/div>\n
\"Lisandro-Sakata\"Editor Associado por Lisandro Sakata<\/strong> Ref.: Short-term enhancement of visual field sensitivity in glaucomatous eyes following surgical intraocular pressure reduction.<\/strong>.
\nWright TM, Goharian I, Gardiner SK, Sehi M, Greenfield DS.
\nAm J Ophthalmol. 2015 Feb;159(2):378-85.
\n<\/span><\/div>\n<\/div>\n

\u201cDoutor, a minha vis\u00e3o vai voltar?\u201d Esta \u00e9 uma pergunta frequente em nossos consult\u00f3rios, ap\u00f3s a indica\u00e7\u00e3o de uma cirurgia de glaucoma para a redu\u00e7\u00e3o da press\u00e3o intraocular (PIO). Na maioria absoluta das vezes a resposta, at\u00e9 por prud\u00eancia, \u00e9: \u201cn\u00e3o, o glaucoma leva a uma perda irrevers\u00edvel da vis\u00e3o\u201d.<\/p>\n

Apesar disto, n\u00e3o raro nos deparamos com pacientes que relatam uma melhora da vis\u00e3o ap\u00f3s o procedimento cir\u00fargico. Baseado nisto, diversos estudos tentam identificar a exist\u00eancia desta melhora. Apesar de alguns estudos descreverem uma diminui\u00e7\u00e3o da escava\u00e7\u00e3o (reversal of optic disc cupping) e um aumento da espessura da camada de fibras nervosas da retina peripapilar ou perimacular, a identifica\u00e7\u00e3o da melhora do campo visual \u00e9 mais subjetiva e controversa.<\/p>\n

Faz sentido acreditar em uma melhora funcional ap\u00f3s a redu\u00e7\u00e3o da PIO uma vez que existem concomitantemente c\u00e9lulas ganglionares saud\u00e1veis, em sofrimento e em processo de apoptose. Talvez esta redu\u00e7\u00e3o da PIO possa melhorar a fun\u00e7\u00e3o e atividade destas c\u00e9lulas ganglionares em sofrimento ou paralisar o processo de apoptose, levando a uma melhora da sensibilidade.<\/p>\n

Wright TM et al realizaram um estudo com um desenho prospectivo interessante. Foram formados 2 grupos de pacientes, um submetidos `a cirurgia anti-glaucomatosa, com 30 olhos e outro controle, com 41 olhos. Os grupos foram equilibrados em rela\u00e7\u00e3o `a idade dos participantes e estadiamento do glaucoma, segundo o MD do campo visual. Todos os pacientes realizaram 2 exames para o baseline e foram realizados 3 exames comparativos no p\u00f3s-operat\u00f3rio.<\/p>\n

Os resultados encontrados demonstraram que mais pontos melhoraram a sensibilidade significativamente no grupo submetido `a cirurgia em rela\u00e7\u00e3o ao grupo controle. Enquanto o grupo submetido `a cirurgia apresentou uma melhora no MD do campo visual em +0,139 dB, o grupo controle piorou em -0,077 dB. Outro ponto importante foi que os grupos foram semelhantes em rela\u00e7\u00e3o aos pontos que apresentaram piora da sensibilidade.<\/p>\n

A recomenda\u00e7\u00e3o pre-operatoria deve manter o tom conservador, onde as cirurgias anti-glaucomatosas tem como intuito preservar a vis\u00e3o existente. Entretanto, os resultados deste estudo sao uteis para interpretar de maneira mais tranquila os coment\u00e1rios positivos de alguns pacientes no pos-operatorio.<\/span><\/p>\n

Diferentemente da Tomografia de Coer\u00eancia \u00d3ptica, que n\u00e3o diferencia uma c\u00e9lula saud\u00e1vel de uma em processo de deteriora\u00e7\u00e3o, a avalia\u00e7\u00e3o funcional p\u00f3s-operat\u00f3ria poderia demonstrar que a revers\u00e3o da disfun\u00e7\u00e3o da c\u00e9lula ganglionar ap\u00f3s a redu\u00e7\u00e3o da PIO. Dentre as poss\u00edveis explica\u00e7\u00f5es estariam a melhora da press\u00e3o de perfus\u00e3o ocular e do fluxo sangu\u00edneo ocular na cabe\u00e7a do nervo \u00f3ptico.<\/p>\n

Apesar disto, este estudo apresentou algumas defici\u00eancias. Primeiramente, n\u00e3o foi estabelecido o n\u00famero de campos visuais realizados antes do baseline. Outro ponto importante \u00e9 a incerteza da capacidade do campo visual em determinar uma disfun\u00e7\u00e3o da c\u00e9lula ganglionar. J\u00e1 o curto espa\u00e7o de acompanhamento foi justificado pelo risco de complica\u00e7\u00f5es no p\u00f3s-operat\u00f3rio, bem como para evitar a interfer\u00eancia da catarata nestes olhos.<\/p>\n

Enfim, n\u00e3o h\u00e1 d\u00favidas de que n\u00e3o raro alguns pacientes relatam melhora da vis\u00e3o ap\u00f3s a cirurgia anti-glaucomatosa. Ficam varias d\u00favidas: se isto se deve a um meio menos hostil, com PIO bem controladas e melhores condi\u00e7\u00f5es para sobreviv\u00eancia e fun\u00e7\u00e3o das c\u00e9lulas retinianas; ou pelo menor uso de hipotensores oculares e, consequentemente, uma menor agress\u00e3o `a superf\u00edcie da c\u00f3rnea. E tamb\u00e9m, se estes resultados se mantem por curto, m\u00e9dio ou longo prazo.<\/p>\n

A recomenda\u00e7\u00e3o pre-operatoria deve manter o tom conservador, onde as cirurgias anti-glaucomatosas tem como intuito preservar a vis\u00e3o existente. Entretanto, os resultados deste estudo sao uteis para interpretar de maneira mais tranquila os coment\u00e1rios positivos de alguns pacientes no pos-operatorio.<\/p>\n

\n
\n

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

Am J Ophthalmol. 2015 Feb;159(2):378-85.e1. doi: 10.1016\/j.ajo.2014.11.012. Epub 2014 Nov 13.
\nShort-term enhancement of visual field sensitivity in glaucomatous eyes following surgical intraocular pressure reduction.
\nWright TM1, Goharian I1, Gardiner SK2, Sehi M1, Greenfield DS3.
\nAuthor information<\/p>\n

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

PURPOSE:<\/strong>
\nTo examine the hypothesis that surgical intraocular pressure (IOP) reduction leads to enhancement of visual field (VF) sensitivity in glaucomatous eyes.<\/p>\n

DESIGN:<\/strong>
\nProspective case-control study.<\/p>\n

PARTICIPANTS:<\/strong>
\nWe recruited 322 eyes of 161 patients with glaucomatous visual field loss from the Diagnostic Innovations Glaucoma Study followed for an average of 3.5\u00b10.7 years.<\/p>\n

METHODS:<\/strong><\/p>\n

Patients with uncontrolled IOP requiring trabeculectomy or aqueous drainage device were enrolled. Controls consisted of medically treated glaucoma patients with stable IOP and no change in medical therapy during follow-up. Two baseline preoperative VFs and 3 follow-up VF examinations at 1, 2, and 3 months postoperatively were used for analysis. The same number of VF examinations measured within an 18-month interval was used for control eyes. VF locations with significant change were defined as exceeding 95% test-retest confidence limits based upon the mean sensitivity using the 2 baseline VF exams. The number of significantly changing locations per eye and changes in mean and pattern standard deviation (PSD) from the mean baseline fields were compared between groups using a Poisson generalized estimating equation model.<\/p>\n

RESULTS:<\/strong>
\nThirty eyes of 30 surgically treated glaucoma patients and 41 eyes of 28 stable controls were enrolled. Postoperative IOP was decreased at follow-up 3 compared with baseline (P < .001) in the surgical eyes, but was similar in control eyes (P = .92). At follow-up 3, the number of test locations improving in central (P = .014) and peripheral (P = .019) VF locations was significantly greater in the surgical eyes. The number of eyes with improved PSD at follow-up 3 was significantly greater in the surgical eyes compared with controls (P = .02).<\/p>\n

CONCLUSIONS:<\/strong>
\nShort-term enhancement of central and peripheral VF sensitivity occurs after surgical reduction of IOP in glaucomatous eyes and may represent a potential biomarker for retinal ganglion cell response to therapeutic interventions in glaucoma.
\nCopyright \u00a9 2015 Elsevier Inc. All rights reserved.<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"

Comentarios por Fabio Kanadani sobre:: Editor Associado por Lisandro Sakata Ref.: Short-term enhancement of visual field sensitivity in glaucomatous eyes following surgical intraocular pressure reduction.. Wright TM, Goharian I, Gardiner SK, Sehi M, Greenfield DS. Am J Ophthalmol. 2015 Feb;159(2):378-85. \u201cDoutor, a minha vis\u00e3o vai voltar?\u201d Esta \u00e9 uma pergunta frequente em nossos consult\u00f3rios, ap\u00f3s […]<\/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-2960","post","type-post","status-publish","format-standard","hentry","category-sem-categoria"],"acf":[],"yoast_head":"\nMelhora do Campo Visual pos-Trabeculectomia? - 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\/campo-visual-vs-cirurgia\/\" \/>\n<meta property=\"og:locale\" content=\"pt_BR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Melhora do Campo Visual pos-Trabeculectomia? - SBG - Sociedade Brasileira de Glaucoma\" \/>\n<meta property=\"og:description\" content=\"Comentarios por Fabio Kanadani sobre:: Editor Associado por Lisandro Sakata Ref.: Short-term enhancement of visual field sensitivity in glaucomatous eyes following surgical intraocular pressure reduction.. 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