{"id":352,"date":"2015-01-23T13:35:14","date_gmt":"2015-01-23T15:35:14","guid":{"rendered":"http:\/\/www.planetaw.com.br\/temp\/sbg\/?p=352"},"modified":"2019-06-24T13:11:17","modified_gmt":"2019-06-24T16:11:17","slug":"taxas-de-progressao-da-camada-de-fibras-nervosas-pelo-oct-em-suspeitos-glaucoma","status":"publish","type":"post","link":"https:\/\/www.sbglaucoma.org.br\/medico\/taxas-de-progressao-da-camada-de-fibras-nervosas-pelo-oct-em-suspeitos-glaucoma\/","title":{"rendered":"TAXAS DE PROGRESS\u00c3O DA CAMADA DE FIBRAS NERVOSAS PELO OCT EM SUSPEITOS GLAUCOMA"},"content":{"rendered":"
\n
\"\"Editor Associado<\/strong>
\nLuciana Alencar<\/strong><\/span><\/span>Comentarios por Luciana M. Alencar sobre:<\/strong>
\nRef.: Rates of retinal nerve fiber layer thinning in glaucoma suspect eyes<\/strong>.
\nMiki A, Medeiros FA, Weinreb RN, Jain S, He F, Sharpsten L, Khachatryan N, Hammel N, Liebmann JM, Girkin CA, Sample PA, Zangwill LM.
\nOphthalmology. 2014 Jul;121(7):1350-8<\/strong>.<\/div>\n<\/div>\n

Suspeitos de glaucoma (seja pelo aspecto lim\u00edtrofe do disco \u00f3ptico e da camada de fibras nervosas, seja pelo aumento da press\u00e3o intraocular) representam um importante grupo de pacientes em nossos consult\u00f3rios. Primeiro por apresentarem risco aumentado de desenvolver glaucoma, principal causa de cegueira irrevers\u00edvel no mundo. Segundo, como j\u00e1 s\u00e3o suspeitos e j\u00e1 est\u00e3o em acompanhamento, dependem de nossas habilidades para que o diagn\u00f3stico seja precoce, na eventualidade de desenvolverem a doen\u00e7a.
\nSabemos hoje que altera\u00e7\u00f5es estruturais podem aparecer antes de seus equivalentes funcionais. O estudo de Miki et al. \u00e9 mais um estudo investigando se exames de OCT espectral obtidos serialmente podem detectar \u2013 antes do aparecimento de defeitos de campo \u2013 uma redu\u00e7\u00e3o progressiva da espessura da camada de fibras nervosas (CFN). O grupo estudado representa justamente 294 indiv\u00edduos suspeitos de glaucoma (454 olhos), que iniciaram o estudo com campimetrias normais. Durante o acompanhamento, aqueles que desenvolveram defeitos de campo visual (40 olhos) apresentaram uma redu\u00e7\u00e3o significantemente mais r\u00e1pida da espessura da CFN (-2,02 \u00b5m\/ano, comparado com -0,82 \u00b5m\/ano nos que n\u00e3o apresentaram defeitos de campo).<\/span> Associado a isso, observaram que cada aumento de 1,0 \u00b5m\/ano na velocidade de redu\u00e7\u00e3o da espessura da CFNDurante o acompanhamento, aqueles que desenvolveram defeitos de campo visual (40 olhos) apresentaram uma redu\u00e7\u00e3o significantemente mais r\u00e1pida da espessura da CFN (-2,02 \u00b5m\/ano, comparado com -0,82 \u00b5m\/ano nos que n\u00e3o apresentaram defeitos de campo). dobrava o risco deste paciente desenvolver um defeito de campo visual.
\nNo entanto, o principal problema da maioria desses estudos ainda \u00e9 o seguimento curto. Este estudo, por exemplo, usou exames obtidos em um per\u00edodo m\u00e9dio de apenas 2,2 anos (variando de 0,4 a 4,1 anos).<\/span> Espera-se que com um maior tempo de seguimento ver\u00edamos um maior n\u00famero de pacientes progredir. Vale ressaltar que mesmo aqueles que n\u00e3o apresentaram defeitos de campo visual durante o per\u00edodo do estudo, apresentaram uma redu\u00e7\u00e3o progressiva e significante da espessura da CFN.Vale ressaltar que mesmo aqueles que n\u00e3o apresentaram defeitos de campo visual durante o per\u00edodo do estudo, apresentaram uma redu\u00e7\u00e3o progressiva e significante da espessura da CFN.<\/span> Esses achados est\u00e3o de acordo com uma s\u00e9rie de outros estudos no mesmo assunto e teremos que aguardar estudos longitudinais mais longos para confirmar se esses pacientes de fato estavam piorando ou se representam resultados falsos positivos. Al\u00e9m disso, devemos lembrar que estudos como esse usam f\u00f3rmulas complexas para ajustar todos os outros fatores relevantes \u00e0 piora e estimar m\u00e9dias. Esses ajustes calculam o efeito isolado da redu\u00e7\u00e3o na espessura da CFN, em um grupo de indiv\u00edduos igualados para todo o resto (idade, press\u00e3o intraocular, gravidade inicial, espessura corneana, etc.), enquanto que nos nossos consult\u00f3rios devemos fazer isso individualmente para cada paciente.<\/p>\n

\n
\n

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

Ophthalmology<\/em>. 2014 Jul;121(7):1350-8. doi: 10.1016\/j.ophtha.2014.01.017. Epub 2014 Mar 13.
\nRates of retinal nerve fiber layer thinning in glaucoma suspect eyes<\/strong>.
\nMiki A1, Medeiros FA2, Weinreb RN2, Jain S3, He F3, Sharpsten L2, Khachatryan N2, Hammel N2, Liebmann JM4, Girkin CA5, Sample PA2, Zangwill LM6.
\nAuthor information<\/strong><\/p>\n

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

PURPOSE<\/strong>:
\nTo compare the rates of retinal nerve fiber layer (RNFL) loss in patients suspected of having glaucoma who developed visual field damage (VFD) with those who did not develop VFD and to determine whether the rate of RNFL loss can be used to predict the development of VFD.<\/p>\n

DESIGN<\/strong>:
\nProspective, observational cohort study.<\/p>\n

PARTICIPANTS<\/strong>:
\nGlaucoma suspects, defined as having glaucomatous optic neuropathy or ocular hypertension (intraocular pressure, >21 mmHg) without repeatable VFD at baseline, from the Diagnostic Innovations in Glaucoma Study and the African Descent and Glaucoma Evaluation Study.<\/p>\n

METHODS<\/strong>:
\nGlobal and quadrant RNFL thickness (RNFLT) were measured with the Spectralis spectral-domain optical coherence tomography (SD-OCT; Spectralis HRA+OCT [Heidelberg Engineering, Heidelberg, Germany]). Visual field damage was defined as having 3 consecutive abnormal visual fields. The rate of RNFL loss in eyes developing VFD was compared to eyes not developing VFD using multivariate linear mixed-effects models. A joint longitudinal survival model used the estimated RNFLT slope to predict the risk of developing VFD, while adjusting for potential confounding variables.<\/p>\n

MAIN OUTCOME MEASURES<\/strong>:
\nEffects of CH, IOP, and CCT on rates of VFI loss over time.<\/p>\n

RESULTS<\/strong>:
\nFour hundred fifty-four eyes of 294 glaucoma suspects were included. The average number of SD-OCT examinations was 4.6 (range, 2-9), with median follow-up of 2.2 years (0.4-4.1 years). Forty eyes (8.8%) developed VFD. The estimated mean rate of global RNFL loss was significantly faster in eyes that developed VFD compared with eyes that did not develop VFD (-2.02 \u03bcm\/year vs. -0.82 \u03bcm\/year; P<0.001). The joint longitudinal survival model showed that each 1-\u03bcm\/year faster rate of global RNFL loss corresponded to a 2.05-times higher risk of developing VFD (hazard ratio, 2.05; 95% confidence interval, 1.14-3.71; P = 0.017).<\/p>\n

CONCLUSIONS<\/strong>:
\nThe rate of global RNFL loss was more than twice as fast in eyes that developed VFD compared with eyes that did not develop VFD. A joint longitudinal survival model showed that a 1-\u03bcm\/year faster rate of RNFLT loss corresponded to a 2.05-times higher risk of developing VFD. These results suggest that measuring the rate of SD-OCT RNFL loss may be a useful tool to help identify patients who are at a high risk of developing visual field loss.<\/p>\n

Copyright \u00a9 2014 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":"

Editor Associado Luciana AlencarComentarios por Luciana M. Alencar sobre: Ref.: Rates of retinal nerve fiber layer thinning in glaucoma suspect eyes. Miki A, Medeiros FA, Weinreb RN, Jain S, He F, Sharpsten L, Khachatryan N, Hammel N, Liebmann JM, Girkin CA, Sample PA, Zangwill LM. Ophthalmology. 2014 Jul;121(7):1350-8. Suspeitos de glaucoma (seja pelo aspecto lim\u00edtrofe […]<\/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-352","post","type-post","status-publish","format-standard","hentry","category-sem-categoria"],"acf":[],"yoast_head":"\nTAXAS DE PROGRESS\u00c3O DA CAMADA DE FIBRAS NERVOSAS PELO OCT EM SUSPEITOS GLAUCOMA - 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\/taxas-de-progressao-da-camada-de-fibras-nervosas-pelo-oct-em-suspeitos-glaucoma\/\" \/>\n<meta property=\"og:locale\" content=\"pt_BR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"TAXAS DE PROGRESS\u00c3O DA CAMADA DE FIBRAS NERVOSAS PELO OCT EM SUSPEITOS GLAUCOMA - SBG - Sociedade Brasileira de Glaucoma\" \/>\n<meta property=\"og:description\" content=\"Editor Associado Luciana AlencarComentarios por Luciana M. 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