{"id":317,"date":"2015-01-23T12:41:20","date_gmt":"2015-01-23T14:41:20","guid":{"rendered":"http:\/\/www.planetaw.com.br\/temp\/sbg\/?p=317"},"modified":"2019-06-24T16:01:11","modified_gmt":"2019-06-24T19:01:11","slug":"grau-de-abertura-angular-vs-pio","status":"publish","type":"post","link":"https:\/\/www.sbglaucoma.org.br\/medico\/grau-de-abertura-angular-vs-pio\/","title":{"rendered":"GRAU DE ABERTURA ANGULAR VS. PIO"},"content":{"rendered":"
\n
\"\"Editor Associado e Comentarios por Mauro Leite sobre:<\/strong>
\nRef: Relationship between intraocular pressure and angle configuration: An anterior segment OCT study.<\/strong>
\nChong RS, Sakata LM, Narayanaswamy AK, Ho SW, He M, Baskaran M, Wong TY, Perera SA, Aung T.
\nIOVS 2013<\/strong>
\n<\/span><\/div>\n<\/div>\n

O aumento da press\u00e3o intraocular (PIO) \u00e9 o principal fator de risco para o desenvolvimento de glaucoma. Em indiv\u00edduos com \u00e2ngulo oclus\u00edvel, o contato entre a \u00edris e o trabeculado pode levar \u00e0 aumento de PIO e, consequentemente, dano glaucomatoso.<\/span> Atualmente, o m\u00e9todo de avalia\u00e7\u00e3o considerado padr\u00e3o \u00e9 a gonioscopia. No entanto, a tomografia de coer\u00eancia \u00f3ptica de seguimento anterior (AS-OCT), fornece dados objetivos sobre as estruturas do seio camerular sem necessidade de contato. Apesar de conseguirmos identificar pacientes com seio camerular oclus\u00edvel, ainda n\u00e3o sabemos quais evoluir\u00e3o para glaucoma prim\u00e1rio de \u00e2ngulo fechado. Usando dados de uma popula\u00e7\u00e3o comunit\u00e1ria extensa, Chong e colaboradores avaliaram a rela\u00e7\u00e3o entre a PIO e a configura\u00e7\u00e3o do \u00e2ngulo, medidos por gonioscopia e AS-OCT.
\nO grupo avaliou 2045 pacientes com mais de 50 anos, recrutados do Singapore Eye Research Hospital. Todos os pacientes inclu\u00eddos no estudo eram assintom\u00e1ticos do ponto de vista oftalmol\u00f3gico no momento da inclus\u00e3o e foram submetidos \u00e0 avalia\u00e7\u00e3o oftalmol\u00f3gica, inclu\u00edndo aferi\u00e7\u00e3o da PIO pelo tonometro de Goldmann, gonioscopia e AS-OCT. O instrumento usado foi o Visante (Carl Zeiss Meditec, Dublin, CA, EUA) e o software usado para analisar as imagens quantitativas foi o Zhongshan Angle Analysis program (Guangzhou, China). A an\u00e1lise principal do estudo correlacionou a PIO com o n\u00famero de quadrantes com contato iris-trabeculado corrigindo para poss\u00edveis vari\u00e1veis de confus\u00e3o como idade, sexo, \u00edndice de massa corp\u00f3rea, espessura corneana, hipertens\u00e3o sist\u00eamica, diabetes e sin\u00e9quias.<\/p>\n

Tanto para a avalia\u00e7\u00e3o feita pela gonioscopia ou AS-OCT, os autores encontraram maiores PIOs em pacientes com maior n\u00famero de quadrantes oclu\u00eddos. Utilizando a avaliacao quantitativa, menores di\u00e2metros e volumes da c\u00e2mara anterior, aberturas de \u00e2ngulo e espa\u00e7os entre o trabeculado e a \u00edris medidos pelo AS-OCT tambem associaram-se a um aumento PIO.<\/span> A presen\u00e7a de sin\u00e9quias anteriores, correlacionou-se com maior n\u00famero de quadrantes fechados, por\u00e9m n\u00e3o com o aumento de PIO. Interessantemente, o AS-OCT foi capaz de detectar o dobro de pacientes com quadrantes fechados comparados \u00e0 gonioscopia.<\/span>
\n“\u00c9 o primeiro estudo a mostrar claramente a rela\u00e7\u00e3o entre extens\u00e3o do fechamento angular e aumento de PIO em um grande n\u00famero de pacientes sem glaucoma. E apesar do AS-OCT ter detectado consideravelmente mais contato iris-trabeculado, essa rela\u00e7\u00e3o entre fechamento angular e PIO mantem-se os tanto na gonioscopia quanto com o AS-OCT.” O estudo \u00e9 importante por pelo menos duas raz\u00f5es. \u00c9 o primeiro estudo a mostrar claramente a rela\u00e7\u00e3o entre extens\u00e3o do fechamento angular e aumento de PIO em um grande n\u00famero de pacientes sem glaucoma. E apesar do AS-OCT ter detectado consideravelmente mais contato iris-trabeculado, essa rela\u00e7\u00e3o entre fechamento angular e PIO mantem-se os tanto na gonioscopia quanto com<\/span> o AS-OCT. Outros estudos futuros devem esclarecer as raz\u00f5es para esses achados. Um dado interessante, por\u00e9m pouco comentado no estudo foi que a PIO n\u00e3o parece aumentar muito entre os grupos com 0, 1, 2 ou 3 quadrantes fechados. Pelos gr\u00e1ficos apresentados, o maior aumento da Pio ocorre principalmente nos pacientes com 4 quadrantes fechados. Os resultados devem ser examinados com cautela na popula\u00e7\u00e3o brasileira j\u00e1 que cerca de 90% dos pacientes do estudo eram chineses.<\/span> Contudo, \u00e9 um estudo bem elaborado que mostra uma rela\u00e7\u00e3o significativa entre a extens\u00e3o do fechamento angular e o aumento de PIO.<\/p>\n

\n
\n

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

Invest Ophthalmol Vis Sci<\/em>. 2013 Mar 5;54(3):1650-5. doi: 10.1167\/iovs.12-9986.
\nRelationship between intraocular pressure and angle configuration: an anterior segment OCT study<\/strong>.
\nChong RS, Sakata LM, Narayanaswamy AK, Ho SW, He M, Baskaran M, Wong TY, Perera SA, Aung T.
\nAuthor information<\/strong><\/p>\n

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

PURPOSE<\/strong>:
\nTo assess the relationship between intraocular pressure (IOP) and anterior chamber angle (ACA) configuration as assessed by gonioscopy and anterior segment optical coherence tomography (AS-OCT).<\/p>\n

METHODS<\/strong>:
\nA total of 2045 subjects aged 50 years and older, were recruited from a community clinic and underwent AS-OCT, Goldmann applanation tonometry, and gonioscopy. A quadrant was classified as closed on gonioscopy if the posterior trabecular meshwork could not be seen. A closed quadrant on AS-OCT was defined by the presence of any contact between the iris and angle wall anterior to the scleral spur. Customized software (Zhongshan Angle Assessment Program, Guangzhou, China) was used to measure AS-OCT parameters on AS-OCT scans, including anterior chamber depth, area, and volume; iris thickness (IT) and curvature; lens vault; angle opening distance; and trabecular-iris space area. IOP values were adjusted for age, sex, diabetes and hypertension status, body mass index, central corneal thickness, and presence of peripheral anterior synechiae.<\/p>\n

RESULTS<\/strong>:
\nMean age of study subjects was 63.2 \u00b1 8.0 years, 52.6% were female, and 89.4% were Chinese. Mean IOP was 14.8 \u00b1 2.4 mm Hg (range 826). IOP (mean \u00b1 SE) increased with number of quadrants with gonioscopic angle closure (none: 14.6 \u00b1 0.2; one: 14.7 \u00b1 0.3; two: 15.0 \u00b1 0.3; three: 15.0 \u00b1 0.3; four: 15.6 \u00b1 0.3 mm Hg; P < 0.001), and on AS-OCT (none: 14.7 \u00b1 0.2; one: 15.0 \u00b1 0.2; two: 14.8 \u00b1 0.2; three: 15.1 \u00b1 0.3; four: 16.0 \u00b1 0.3 mm Hg; P < 0.001). IOP also increased in association with most of the ACA quantitative parameters measured on AS-OCT images, except for IT and lens vault.
\nCONCLUSIONS<\/strong>:
\nThere was an association between the extent of angle closure, as assessed on AS-OCT and gonioscopy, with increasing IOP.<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"

Editor Associado e Comentarios por Mauro Leite sobre: Ref: Relationship between intraocular pressure and angle configuration: An anterior segment OCT study. Chong RS, Sakata LM, Narayanaswamy AK, Ho SW, He M, Baskaran M, Wong TY, Perera SA, Aung T. IOVS 2013 O aumento da press\u00e3o intraocular (PIO) \u00e9 o principal fator de risco para o […]<\/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-317","post","type-post","status-publish","format-standard","hentry","category-sem-categoria"],"acf":[],"yoast_head":"\nGRAU DE ABERTURA ANGULAR VS. 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