{"id":330,"date":"2015-01-23T12:58:32","date_gmt":"2015-01-23T14:58:32","guid":{"rendered":"http:\/\/www.planetaw.com.br\/temp\/sbg\/?p=330"},"modified":"2019-06-24T16:12:37","modified_gmt":"2019-06-24T19:12:37","slug":"perspectivas-futuras-na-analise-da-rima-neural-com-oct","status":"publish","type":"post","link":"https:\/\/www.sbglaucoma.org.br\/medico\/perspectivas-futuras-na-analise-da-rima-neural-com-oct\/","title":{"rendered":"PERSPECTIVAS FUTURAS NA AN\u00c1LISE DA RIMA NEURAL COM OCT"},"content":{"rendered":"
\n
\"\"Comentarios de Cristiano Caixeta Umbelino sobre<\/strong>:
\nRef.: Enhanced detection of open-angle glaucoma with an anatomically accurate optical coherence tomography-derived neuroretinal rim parameter<\/strong>.
\nChauhan BC, O’Leary N, Almobarak FA, Reis AS, Yang H, Sharpe GP, Hutchison DM, Nicolela MT, Burgoyne CF..
\nOphthalmology 2013<\/strong>
\n<\/span><\/div>\n
\"\"Editor Associado<\/strong>
\nNiro Kasahara<\/strong>
\n<\/span><\/div>\n<\/div>\n

A quantifica\u00e7\u00e3o precisa do tecido neuro-retiniano \u00e9 um desafio grande. A determina\u00e7\u00e3o do limite da escava\u00e7\u00e3o e a margem do disco s\u00e3o detalhes de grande import\u00e2ncia na analise do disco \u00f3ptico. A delimita\u00e7\u00e3o atrav\u00e9s planos de refer\u00eancia adotando estruturas anat\u00f4micas da retina e nervo \u00f3ptico podem ser de grande valia na analise dos pacientes.<\/span> Contudo devemos lembrar sempre que existem varia\u00e7\u00f5es anat\u00f4micas que podem comprometer a an\u00e1lise.<\/p>\n

Chauhan et al, apresentam um novo m\u00e9todo para definir a rima tecidual neuro-retiniana. Os autores consideram, de acordo com os resultados encontrados neste estudo, que o melhor par\u00e2metro para analisar a rima neural seria atrav\u00e9s da avalia\u00e7\u00e3o BMO – MRW onde BMO (Bruch\u2019s membrane opening) e MRW (minimum rim width) – largura m\u00ednima da rima, que corresponde a dist\u00e2ncia m\u00ednima entre BMO e a membrana limitante interna (ILM).<\/p>\n

Segundo os autores, a utilizacao deste metodo no local proposto representa um melhor metodo para avaliar a quantidade de axonios do que a avaliacao da camadas de fibras nervosas ao redor da papila. Globalmente, a an\u00e1lise da BMO – MRW apresentou melhor desempenho diagn\u00f3stico nos paciente portadores de glaucoma do que a an\u00e1lise de outros par\u00e2metros avaliados, como por exemplo: RNFLT (espessura da camada fibras nervosas ret\u00ednicas peri-papilar),<\/span> BMO – HRW onde HRW largura da rima horizontal, a an\u00e1lise da dist\u00e2ncia entre BMO e a ILM (membrana limitante interna) no plano de refer\u00eancia BMO, e os par\u00e2metros da MRA (Moorfields An\u00e1lise de Regress\u00e3o) obtidos com o HRT.<\/p>\n

“Com o novo par\u00e2metro estrutural BMO – MRW, a quantidade total de ax\u00f4nios pode ser representada de forma mais precisa do que com a analise da RNFLT da circunfer\u00eancia peri-papila.”<\/span>Com o novo par\u00e2metro estrutural BMO – MRW, a quantidade total de ax\u00f4nios pode ser representada de forma mais precisa do que com a analise da RNFLT da circunfer\u00eancia peri-papila.” Este dado pode ocorrer porque a \u00e1rea de an\u00e1lise do tecido neural \u00e9 medida na BMO, \u00e9 mais estreito para o local danificado do que no di\u00e2metro de 3,46 mil\u00edmetros, que \u00e9 a largura do c\u00edrculo peri-papilar de medida perpendicularmente aos ax\u00f4nios adotada para analise da RNFLT. Uma \u00e1rea maior de an\u00e1lise pode estar sujeita a mais erro de medi\u00e7\u00e3o devido a uma varia\u00e7\u00e3o individual na orienta\u00e7\u00e3o do tecido neural em torno da margem do disco.<\/p>\n

Para refor\u00e7ar as conclus\u00f5es deste estudo o n\u00famero de participantes deveria ser ampliado tendo em vista que neste estudo a an\u00e1lise compreendeu um grupo controle de tamanho pequeno (n = 48) em rela\u00e7\u00e3o ao n\u00famero de pacientes com glaucoma (n = 107).<\/p>\n

“Outros centros de pesquisa utilizando diferente populacoes devem confirmar a utilidade destes novos metodos de analise estrutural automatizada.”<\/span>Outros centros de pesquisa utilizando diferente populacoes devem confirmar a utilidade destes novos metodos de analise estrutural automatizada. A exclusao de paciente portadores discos \u00f3ptico inclinados e com \u00e1reas de atrofias peri-papilares, e a an\u00e1lise de uma faixa restrita de erro refracional (\u00b1 6,00 dioptrias esf\u00e9ricas, \u00b1 3,00 dioptrias cil\u00edndricas) podem superestimar a performance destes novos parametros, e impedem a generalizacao dos achados deste estudo para os pacientes do dia a dia do consultorio.<\/p>\n

Veja coment\u00e1rios do International Glaucoma Review sobre este artigo:
\nhttp:\/\/www.e-igr.com\/ABS\/index.php?AbID=51993&page=Abstracts&issue=144<\/a><\/p>\n

\n
\n

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

Ophthalmology<\/em>. 2013 Mar;120(3):535-43. doi: 10.1016\/j.ophtha.2012.09.055. Epub 2012 Dec 23.
\nEnhanced detection of open-angle glaucoma with an anatomically accurate optical coherence tomography-derived neuroretinal rim parameter<\/strong>.
\nChauhan BC, O’Leary N, Almobarak FA, Reis AS, Yang H, Sharpe GP, Hutchison DM, Nicolela MT, Burgoyne CF.
\nAuthor information<\/strong><\/p>\n

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

OBJECTIVE<\/strong>:
\nNeuroretinal rim assessment based on the clinical optic disc margin (DM) lacks a sound anatomic basis for 2 reasons: (1) The DM is not reliable as the outer border of rim tissue because of clinically and photographically invisible extensions of Bruch’s membrane (BM) inside the DM and (2) nonaccountability of rim tissue orientation in the optic nerve head (ONH). The BM opening-minimum rim width (BMO-MRW) is a parameter that quantifies the rim from its true anatomic outer border, BMO, and accounts for its variable orientation. We report the diagnostic capability of BMO-MRW.<\/p>\n

DESIGN<\/strong>:
\nCase control.
\nPARTICIPANTS<\/strong>:
\nPatients with open-angle glaucoma (n = 107) and healthy controls (n = 48).<\/p>\n

METHODS<\/strong>:
\nSpectral-domain optical coherence tomography (SD-OCT) with 24 radial and 1 circumpapillary B-scans, centered on the ONH, and confocal scanning laser tomography (CSLT) were performed. The internal limiting membrane (ILM) and BMO were manually segmented in each radial B-scan. Three SD-OCT parameters were computed globally and sectorally: (1) circumpapillary retinal nerve fiber layer thickness (RNFLT); (2) BMO-horizontal rim width (BMO-HRW), the distance between BMO and ILM in the BMO reference plane; and (3) BMO-MRW, the minimum distance between BMO and ILM. Moorfields Regression Analysis (MRA) with CLST was performed globally and sectorally to yield MRA1 and MRA2, where “borderline” was classified as normal and abnormal, respectively.<\/p>\n

MAIN OUTCOME MEASURES<\/strong>:
\nSensitivity, specificity, and likelihood ratios (LRs) for positive and negative test results (LR+\/LR-).<\/p>\n

RESULTS<\/strong>:
\nThe median (interquartile range) age and mean deviation of patients and controls were 69.9 (64.3-76.9) and 65.0 (58.1-74.3) years and -3.92 (-7.87 to -1.62) and 0.33 (-0.32 to 0.98) dB, respectively. Globally, BMO-MRW yielded better diagnostic performance than the other parameters. At 95% specificity, the sensitivity of RNFLT, BMO-HRW, and BMO-MRW was 70%, 51%, and 81%, respectively. The corresponding LR+\/LR- was 14.0\/0.3, 10.2\/0.5, and 16.2\/0.2. Sectorally, at 95% specificity, the sensitivity of RNFLT ranged from 31% to 59%, of BMO-HRW ranged from 35% to 64%, and of BMO-MRW ranged from 54% to 79%. Globally and in all sectors, BMO-MRW performed better than MRA1 or MRA2.<\/p>\n

CONCLUSIONS<\/strong>:
\nThe higher sensitivity at 95% specificity in early glaucoma of BMO-MRW compared with current BMO methods is significant, indicating a new structural marker for the detection and risk profiling of glaucoma.
\nCopyright \u00a9 2013 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"

Comentarios de Cristiano Caixeta Umbelino sobre: Ref.: Enhanced detection of open-angle glaucoma with an anatomically accurate optical coherence tomography-derived neuroretinal rim parameter. Chauhan BC, O’Leary N, Almobarak FA, Reis AS, Yang H, Sharpe GP, Hutchison DM, Nicolela MT, Burgoyne CF.. Ophthalmology 2013 Editor Associado Niro Kasahara A quantifica\u00e7\u00e3o precisa do tecido neuro-retiniano \u00e9 um desafio […]<\/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-330","post","type-post","status-publish","format-standard","hentry","category-sem-categoria"],"acf":[],"yoast_head":"\nPERSPECTIVAS FUTURAS NA AN\u00c1LISE DA RIMA NEURAL COM OCT - 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\/perspectivas-futuras-na-analise-da-rima-neural-com-oct\/\" \/>\n<meta property=\"og:locale\" content=\"pt_BR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"PERSPECTIVAS FUTURAS NA AN\u00c1LISE DA RIMA NEURAL COM OCT - SBG - Sociedade Brasileira de Glaucoma\" \/>\n<meta property=\"og:description\" content=\"Comentarios de Cristiano Caixeta Umbelino sobre: Ref.: Enhanced detection of open-angle glaucoma with an anatomically accurate optical coherence tomography-derived neuroretinal rim parameter. 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