{"id":297,"date":"2015-01-23T12:20:36","date_gmt":"2015-01-23T14:20:36","guid":{"rendered":"http:\/\/www.planetaw.com.br\/temp\/sbg\/?p=297"},"modified":"2019-06-24T15:43:45","modified_gmt":"2019-06-24T18:43:45","slug":"aumento-da-pio-no-decubito-lateral","status":"publish","type":"post","link":"https:\/\/www.sbglaucoma.org.br\/medico\/aumento-da-pio-no-decubito-lateral\/","title":{"rendered":"AUMENTO DA PIO NO DEC\u00daBITO LATERAL – “SUA ATEN\u00c7\u00c3O ESPECIAL PARA”"},"content":{"rendered":"
\n
\"\"Comentarios de Carmo Mandia sobre:<\/strong>
\nRef.: The effect of lateral decubitus position on intraocular pressure in patients with untreated open-angle glaucoma.
\nLee JY, Yoo C, Kim YY.
\nAm J Ophthalmol 2013
\n<\/span><\/div>\n
\"\"Editor Associado<\/strong>
\nNiro Kasahara<\/strong><\/span><\/div>\n<\/div>\n

A press\u00e3o intraocular (PIO) elevada \u00e9 o maior fator de risco, tanto para o desenvolvimento como para a progress\u00e3o do glaucoma. Estudos das altera\u00e7\u00f5es posturais demonstraram sua influ\u00eancia sobre a PIO, particularmente a eleva\u00e7\u00e3o da PIO da posi\u00e7\u00e3o sentada para a posi\u00e7\u00e3o supina, que ocorre tanto em olhos normais como glaucomatosos.
\nEm olhos normais, a mudan\u00e7a de dec\u00fabito supino para dec\u00fabito lateral provoca eleva\u00e7\u00e3o da PIO no olho dependente (o olho em posi\u00e7\u00e3o inferior no dec\u00fabito lateral).<\/span><\/p>\n

“Assim, at\u00e9 que se entenda melhor a import\u00e2ncia do dec\u00fabito na PIO e se verifiquem as mesmas altera\u00e7\u00f5es nos pacientes com glaucoma sob tratamento, parece cedo que passemos a orientar pacientes com glaucoma unilateral para que deitem ou em posi\u00e7\u00e3o supina ou em dec\u00fabito lateral oposto ao olho glaucomatoso.”<\/span>Lee et al. estudaram o comportamento da PIO em olhos com glaucoma sem tratamento, em rela\u00e7\u00e3o \u00e0 mudan\u00e7a de posi\u00e7\u00e3o supina para o dec\u00fabito lateral. A PIO em posi\u00e7\u00e3o supina foi maior que na posi\u00e7\u00e3o sentada. E da posi\u00e7\u00e3o supina para o dec\u00fabito lateral houve um aumento da PIO que variou entre 1,9 e 2,0 mmHg no olho dependente. Apesar de pequeno, esse aumento da PIO pode ser significante em olhos glaucomatosos. Al\u00e9m disso, os olhos com maiores defeitos de campo visual mostraram uma tend\u00eancia a maiores eleva\u00e7\u00f5es da PIO, da posi\u00e7\u00e3o supina para o dec\u00fabito lateral.<\/span><\/p>\n

Este estudo apresenta algumas limita\u00e7\u00f5es. O tempo de perman\u00eancia nas diferentes posi\u00e7\u00f5es foi de apenas 10 minutos e, al\u00e9m disso, os pacientes n\u00e3o estavam dormindo. N\u00e3o se analisou o comportamento dos olhos sob tratamento cl\u00ednico nem os efeitos da press\u00e3o do travesseiro sobre o olho. A press\u00e3o de perfus\u00e3o ocular e a press\u00e3o liqu\u00f3rica n\u00e3o foram analisadas e podem sofrer altera\u00e7\u00f5es com a mudan\u00e7a postural. Assim, at\u00e9 que se entenda melhor a import\u00e2ncia do dec\u00fabito na PIO e se verifiquem as mesmas altera\u00e7\u00f5es nos pacientes com glaucoma sob tratamento, parece cedo que passemos a orientar pacientes com glaucoma unilateral para que deitem ou em posi\u00e7\u00e3o supina ou em dec\u00fabito lateral oposto ao olho glaucomatoso.<\/p>\n

http:\/\/www.e-igr.com\/ES\/index.php?issue=144&ComID=1193<\/a>
\nhttp:\/\/www.e-igr.com\/ES\/index.php?issue=144&ComID=1194<\/a><\/p>\n

\n
\n

\"\"\u00a0Editor Associado e Comentarios por Ricardo Paletta Guedes sobre:<\/strong>Ref.: Effect of lateral decubitus position on intraocular pressure in glaucoma patients with\u00a0<\/strong>
\nasymmetric visual field loss.<\/strong>
\nKim KN, Jeoung JW, Park KH, Lee DS, Kim DM.
\nOphthalmology 2013; 120(4): 731-5.<\/strong><\/span><\/p>\n

 <\/p>\n<\/div>\n<\/div>\n

A press\u00e3o intraocular \u00e9 um par\u00e2metro din\u00e2mico que pode variar de acordo com algumas situa\u00e7\u00f5es, tais como hora do dia, posi\u00e7\u00e3o do corpo, ingest\u00e3o de l\u00edquidos ou medicamentos, ritmo nictemeral do paciente, etc.<\/p>\n

Entre os poss\u00edveis modificadores da press\u00e3o intraocular est\u00e3o as mudan\u00e7as posturais. Estes autores avaliaram a poss\u00edvel influ\u00eancia da posi\u00e7\u00e3o habitual de sono (dec\u00fabito lateral direito ou esquerdo) sobre a press\u00e3o intraocular e a severidade do dano glaucomatoso.<\/p>\n

Cada paciente estudado teve um olho classificado como melhor (dano menos severo na perimetria) e o outro como pior (dano mais severo na perimetria).<\/p>\n

Os resultados apresentados mostram que na posi\u00e7\u00e3o sentada n\u00e3o havia diferen\u00e7as entre as press\u00f5es do melhor ou do pior olho. Na posi\u00e7\u00e3o deitada em dec\u00fabito dorsal, o olho considerado pior apresentou uma eleva\u00e7\u00e3o estatisticamente significante maior que o olho melhor. O mesmo se correlacionou com a posi\u00e7\u00e3o preferencial de dec\u00fabito (auto-informada atrav\u00e9s de question\u00e1rio).<\/span><\/p>\n

Os autores concluem que a posi\u00e7\u00e3o habitual de sono (dec\u00fabito lateral direito ou esquerdo) pode estar associada uma maior eleva\u00e7\u00e3o da PIO em um dos olhos, levando a uma dano assim\u00e9trico de campo visual.<\/span><\/p>\n

Veja coment\u00e1rios do International Glaucoma Review sobre este artigo:
\nhttp:\/\/www.e-igr.com\/ES\/index.php?issue=144&ComID=1193<\/a>
\nhttp:\/\/www.e-igr.com\/ES\/index.php?issue=144&ComID=1194<\/a><\/p>\n

\n
\n

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

Ophthalmology<\/em>. 2013 Apr;120(4):731-5. doi: 10.1016\/j.ophtha.2012.09.021. Epub 2012 Dec 20.
\nEffect of lateral decubitus position on intraocular pressure in glaucoma patients with asymmetric visual field loss<\/strong>.
\nKim KN, Jeoung JW, Park KH, Lee DS, Kim DM.
\nAuthor information<\/strong><\/p>\n

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

PURPOSE<\/strong>:
\nTo investigate the effect of the lateral decubitus position (LDP) on intraocular pressure (IOP) in glaucoma patients with asymmetric visual field loss.<\/p>\n

DESIGN<\/strong>:
\nProspective, cross-sectional study.<\/p>\n

PARTICIPANTS<\/strong>:
\nNinety-eight eyes of 49 consecutive bilateral glaucoma patients with asymmetric visual field loss, divided into better eye and worse eye groups for calculation of mean deviation.<\/p>\n

METHODS<\/strong>:
\nIntraocular pressure was measured using a Goldmann applanation tonometer and rebound tonometer (Icare PRO; Icare Finland Oy, Helsinki, Finland) in each of the following positions: sitting, supine, right LDP, and left LDP. Visual field was examined using the Humphrey Field Analyzer (HFA II; Carl Zeiss Meditec, Dublin, CA). A questionnaire on the preferred lying position during sleep was administered to each of the patients.<\/p>\n

MAIN OUTCOME MEASURES<\/strong>:
\nThe IOPs measured by rebound tonometer for the better and worse eyes in each position were compared using paired t tests. Agreement between the Goldmann applanation tonometry and rebound tonometry results was assessed by a Bland-Altman plot.<\/p>\n

RESULTS<\/strong>:
\nThe IOPs of the better and worse eyes in the sitting position showed no significant difference (P<0.476). The IOP of the worse eye was significantly higher than that of the better eye in the supine position (16.8 \u00b1 3.0 mmHg vs. 15.1 \u00b1 1.8 mmHg; P<0.001). The IOPs of the worse and better eyes in their dependent LDP were 19.1 \u00b1 3.0 mmHg and 17.6 \u00b1 2.3 mmHg, respectively (change in IOP, 1.6 \u00b1 2.4 mmHg; P<0.001). Of the enrolled patients, 75.5% preferred the LDP, and 75.7% of these LDP-preferring patients preferred the worse eye dependent-LDP. The Bland-Altman plot comparing the Goldmann applanation tonometry and rebound tonometry readings showed reasonable agreement between the 2 methods (r(2)<0.001; P = 0.972).<\/p>\n

CONCLUSIONS<\/strong>:
\nThis study showed that IOP-elevation asymmetry in LDP is associated with asymmetric visual field loss in glaucoma patients. The LDP, habitually preferred by glaucoma patients, also may be associated with asymmetric visual field damage.<\/p>\n

Copyright \u00a9 2013 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.
\nPMID: 23260257 [PubMed – indexed for MEDLINE]<\/p>\n

Am J Ophthalmol<\/em>. 2013 Feb;155(2):329-335.e2. doi: 10.1016\/j.ajo.2012.08.003. Epub 2012 Oct 27.
\nThe effect of lateral decubitus position on intraocular pressure in patients with untreated open-angle glaucoma<\/strong>.
\nLee JY, Yoo C, Kim YY.
\nAuthor information<\/strong><\/p>\n

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

PURPOSE<\/strong>:
\nTo investigate the effect of change of body posture from the supine to the lateral decubitus position on intraocular pressure (IOP) in patients with open-angle glaucoma.<\/p>\n

DESIGN<\/strong>:
\nProspective, observational case series.<\/p>\n

METHODS<\/strong>:
\nSetting. Institutional. Participants. Forty-four eyes of 22 patients with newly diagnosed bilateral open-angle glaucoma. Observation procedures. IOP was measured using the Tono-Pen XL (Reichert Inc) in both eyes 10 minutes after assuming each position: sitting, supine, right lateral decubitus, supine, left lateral decubitus, and supine. By comparing the mean deviation (MD) of Humphrey visual field between both eyes of a patient, eyes were classified into either worse-MD eye or better-MD eye. Main outcome measures. Magnitude of IOP alterations by postural changes and intereye difference of IOP with each posture.<\/p>\n

RESULTS<\/strong>:
\nThe mean \u00b1 SD IOP of the dependent eyes (eye on the lower side in the lateral decubitus position) increased after changing from the supine to the right lateral decubitus position (19.1 \u00b1 2.6 mm Hg vs 21.0 \u00b1 2.7 mm Hg; P = .019) or the left lateral decubitus position (18.6 \u00b1 2.9 mm Hg vs 20.6 \u00b1 3.1 mm Hg; P = .002). The mean IOP of the dependent eyes was significantly higher than that of the nondependent eyes in the lateral decubitus positions (right lateral decubitus, +1.2 mm Hg; left lateral decubitus, +1.6 mm Hg; both, P < .05). Compared with the better-MD eyes, the worse-MD eyes showed a tendency for greater IOP rise with positional change from the supine to lateral decubitus position (2.3 \u00b1 2.2 mm Hg vs 1.5 \u00b1 2.1 mm Hg; P = .065).<\/p>\n

CONCLUSIONS<\/strong>:
\nThe postural change from the supine to lateral decubitus position may increase the IOP of the dependent eyes in patients with open-angle glaucoma.<\/p>\n

Copyright \u00a9 2013 Elsevier Inc. All rights reserved.<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"

Comentarios de Carmo Mandia sobre: Ref.: The effect of lateral decubitus position on intraocular pressure in patients with untreated open-angle glaucoma. Lee JY, Yoo C, Kim YY. Am J Ophthalmol 2013 Editor Associado Niro Kasahara A press\u00e3o intraocular (PIO) elevada \u00e9 o maior fator de risco, tanto para o desenvolvimento como para a progress\u00e3o do […]<\/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-297","post","type-post","status-publish","format-standard","hentry","category-sem-categoria"],"acf":[],"yoast_head":"\nAUMENTO DA PIO NO DEC\u00daBITO LATERAL - "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\/aumento-da-pio-no-decubito-lateral\/\" \/>\n<meta property=\"og:locale\" content=\"pt_BR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"AUMENTO DA PIO NO DEC\u00daBITO LATERAL - "SUA ATEN\u00c7\u00c3O ESPECIAL PARA" - SBG - Sociedade Brasileira de Glaucoma\" \/>\n<meta property=\"og:description\" content=\"Comentarios de Carmo Mandia sobre: Ref.: The effect of lateral decubitus position on intraocular pressure in patients with untreated open-angle glaucoma. 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Am J Ophthalmol 2013 Editor Associado Niro Kasahara A press\u00e3o intraocular (PIO) elevada \u00e9 o maior fator de risco, tanto para o desenvolvimento como para a progress\u00e3o do […]\" \/>\n<meta property=\"og:url\" content=\"https:\/\/www.sbglaucoma.org.br\/medico\/aumento-da-pio-no-decubito-lateral\/\" \/>\n<meta property=\"og:site_name\" content=\"SBG - Sociedade Brasileira de Glaucoma\" \/>\n<meta property=\"article:published_time\" content=\"2015-01-23T14:20:36+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2019-06-24T18:43:45+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/sbglaucoma2.websiteseguro.com\/medico\/wp-content\/uploads\/2015\/01\/Carmo.jpg\" \/>\n<meta name=\"author\" content=\"Ricardo\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Escrito por\" \/>\n\t<meta name=\"twitter:data1\" content=\"Ricardo\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. tempo de leitura\" \/>\n\t<meta name=\"twitter:data2\" content=\"7 minutos\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\\\/\\\/www.sbglaucoma.org.br\\\/medico\\\/aumento-da-pio-no-decubito-lateral\\\/#article\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/www.sbglaucoma.org.br\\\/medico\\\/aumento-da-pio-no-decubito-lateral\\\/\"},\"author\":{\"name\":\"Ricardo\",\"@id\":\"https:\\\/\\\/www.sbglaucoma.org.br\\\/medico\\\/#\\\/schema\\\/person\\\/3b5653b1267e6a6d05de21f0ebd8e3c2\"},\"headline\":\"AUMENTO DA PIO NO DEC\u00daBITO LATERAL – “SUA ATEN\u00c7\u00c3O ESPECIAL PARA”\",\"datePublished\":\"2015-01-23T14:20:36+00:00\",\"dateModified\":\"2019-06-24T18:43:45+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\\\/\\\/www.sbglaucoma.org.br\\\/medico\\\/aumento-da-pio-no-decubito-lateral\\\/\"},\"wordCount\":1385,\"commentCount\":0,\"image\":{\"@id\":\"https:\\\/\\\/www.sbglaucoma.org.br\\\/medico\\\/aumento-da-pio-no-decubito-lateral\\\/#primaryimage\"},\"thumbnailUrl\":\"https:\\\/\\\/sbglaucoma.org.br\\\/medico\\\/wp-content\\\/uploads\\\/2015\\\/01\\\/Carmo.jpg\",\"inLanguage\":\"pt-BR\",\"potentialAction\":[{\"@type\":\"CommentAction\",\"name\":\"Comment\",\"target\":[\"https:\\\/\\\/www.sbglaucoma.org.br\\\/medico\\\/aumento-da-pio-no-decubito-lateral\\\/#respond\"]}]},{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/www.sbglaucoma.org.br\\\/medico\\\/aumento-da-pio-no-decubito-lateral\\\/\",\"url\":\"https:\\\/\\\/www.sbglaucoma.org.br\\\/medico\\\/aumento-da-pio-no-decubito-lateral\\\/\",\"name\":\"AUMENTO DA PIO NO DEC\u00daBITO LATERAL - 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