{"id":348,"date":"2015-01-23T13:29:20","date_gmt":"2015-01-23T15:29:20","guid":{"rendered":"http:\/\/www.planetaw.com.br\/temp\/sbg\/?p=348"},"modified":"2019-06-24T13:44:30","modified_gmt":"2019-06-24T16:44:30","slug":"ohts-velocidade-de-progressao-estrutural-pelo-hrt","status":"publish","type":"post","link":"https:\/\/www.sbglaucoma.org.br\/medico\/ohts-velocidade-de-progressao-estrutural-pelo-hrt\/","title":{"rendered":"OHTS: VELOCIDADE DE PROGRESS\u00c3O ESTRUTURAL PELO HRT \u2013 \u201cSUA ATEN\u00c7\u00c3O ESPECIAL PARA\u201d"},"content":{"rendered":"
\n
\"\"Co\"Daniela-L-M-Junqueira\"ment\u00e1rios de Tiago Prata e Dra Daniela L M Junqueira sobre<\/strong>:
\nRef.: The rate of structural change: the Confocal Scanning Laser Ophthalmoscopy ancillary study to the Ocular Hypertension Treatment Study.<\/strong>
\nZangwill LM, Jain S, Dirkes K, He F, Medeiros FA, Trick GL, Brandt JD, Cioffi GA, Coleman AL, Liebmann JM, Piltz-Seymour JR, Gordon MO, Kass MA, Weinreb RN.
\nAm J Ophthalmol. 2013
\n<\/span><\/span><\/div>\n
E\"\"ditor Associado<\/strong>
\nTiago Prata<\/strong>
\n<\/span><\/span><\/div>\n<\/div>\n

Este estudo tem como base os dados topogr\u00e1ficos obtidos dos pacientes do Ocular Hypertension Treatment Study (OHTS). O OHTS foi um ensaio cl\u00ednico randomizado que avaliou a taxa de convers\u00e3o de pacientes hipertensos oculares em glaucomatosos, a influ\u00eancia da redu\u00e7\u00e3o press\u00f3rica nessa taxa e fatores de risco associados \u00e0 convers\u00e3o.<\/p>\n

A pergunta a ser respondida no presente estudo foi: existe diferen\u00e7a na taxa de mudan\u00e7a da topografia da cabe\u00e7a do nervo \u00f3ptico ao longo do tempo entre pacientes suspeitos que desenvolveram glaucoma e aqueles que n\u00e3o desenvolveram a doen\u00e7a?<\/p>\n

“foi identificada uma taxa de perda da \u00e1rea da rima neural (atrav\u00e9s da oftalmoscopia confocal de varredura \u00e0 laser) cinco vezes mais r\u00e1pida nos olhos que desenvolveram glaucoma quando comparados aos olhos que n\u00e3o desenvolveram. Nesses olhos, aqueles com maior press\u00e3o intraocular ao longo do seguimento tamb\u00e9m tiveram maior taxa de perda da rima.”<\/span>Analisando os 441 pacientes (832 olhos) inclu\u00eddos, foi identificada uma taxa de perda da \u00e1rea da rima neural (atrav\u00e9s da oftalmoscopia confocal de varredura \u00e0 laser) cinco vezes mais r\u00e1pida nos olhos que desenvolveram glaucoma quando comparados aos olhos que n\u00e3o desenvolveram. Nesses olhos, aqueles com maior press\u00e3o intraocular ao longo do seguimento tamb\u00e9m tiveram maior taxa de perda da rima. Chama a aten\u00e7\u00e3o o longo tempo de seguimento dos pacientes desse estudo, no qual os pacientes foram acompanhados em m\u00e9dia por mais de 10 anos (mediana do tempo de seguimento foi de 11 anos para os pacientes que n\u00e3o desenvolveram glaucoma).<\/p>\n

Esses resultados sugerem que a avalia\u00e7\u00e3o da taxa de perda da rima neural pode ser um bom indicador para acompanhamento de pacientes com hipertens\u00e3o ocular. Vale a pena ressaltar que embora mais lenta, a taxa de perda da \u00e1rea da rima neural tamb\u00e9m foi significante nos pacientes hipertensos oculares que n\u00e3o desenvolveram glaucoma. Nesses casos, s\u00f3 um seguimento mais longo ir\u00e1 dizer se essa perda est\u00e1 relacionada ao envelhecimento ou se j\u00e1 representa dano glaucomatoso inicial.<\/span><\/p>\n

\n
\n

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

Am J Ophthalmol<\/em>. 2013 Jun;155(6):971-82. doi: 10.1016\/j.ajo.2013.01.020. Epub 2013 Mar 14.
\nThe rate of structural change: the confocal scanning laser ophthalmoscopy ancillary study to the ocular hypertension treatment study<\/strong>.
\nZangwill LM, Jain S, Dirkes K, He F, Medeiros FA, Trick GL, Brandt JD, Cioffi GA, Coleman AL, Liebmann JM, Piltz-Seymour JR, Gordon MO, Kass MA, Weinreb RN; Confocal Scanning Laser Ophthalmoscopy Ancillary Study to the Ocular Hypertension Treatment Study.
\nAuthor information<\/strong><\/p>\n

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

PURPOSE<\/strong>:
\nTo compare rates of topographic change in ocular hypertensive eyes that develop primary open-angle glaucoma (POAG) compared to eyes that do not, and to identify factors that influence the rate of change.<\/p>\n

DESIGN<\/strong>:
\nLongitudinal, randomized clinical trial.<\/p>\n

METHODS<\/strong>:
\nFour hundred forty-one participants (832 eyes) in the Confocal Scanning Laser Ophthalmoscopy Ancillary Study to the Ocular Hypertension Treatment Study were included. POAG was defined as repeatable visual field, photography-based optic disc changes, or both. The rate of topographic change in the 52 participants (66 eyes) who developed POAG was compared with that of participants who did not develop POAG using multivariable mixed effects models.<\/p>\n

RESULTS<\/strong>:
\nIn both univariate and multivariate analyses, the rate of rim area loss was significantly faster in eyes in which POAG developed than in eyes in which it did not (univariate mean, -0.0131 mm(2)\/year and -0.0026 mm(2)\/year, respectively). The significantly faster rate of rim area loss in black persons found in the univariate analysis did not remain significant when baseline disc area was included in the model. In multivariate analyses, the rate of rim area loss and other topographic parameters also was significantly faster in eyes with worse baseline visual field pattern standard deviation and higher intraocular pressure during follow-up. Moreover, a significant rate of rim area loss was detected in eyes in which POAG did not develop (P < .0001). The rate of rim area loss in eyes with an optic disc POAG endpoint was significantly faster than in those with a visual field POAG endpoint.<\/p>\n

CONCLUSIONS<\/strong>:
\nThe rate of rim area loss is approximately 5 times faster in eyes in which POAG developed compared with eyes in which it did not. These results suggest that measuring the rate of structural change can provide important information for the clinical management of ocular hypertensive patients. Additional follow-up is needed to determine whether the statistically significant change in the eyes in which POAG did not develop represents normal aging or glaucomatous change not detected by conventional methods.<\/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":"

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