{"id":361,"date":"2015-01-23T14:20:55","date_gmt":"2015-01-23T16:20:55","guid":{"rendered":"http:\/\/www.planetaw.com.br\/temp\/sbg\/?p=361"},"modified":"2019-06-11T13:09:08","modified_gmt":"2019-06-11T16:09:08","slug":"iridotomia-na-sindrome-de-dispersao-pigmentar-estudo-clinico-randomizado","status":"publish","type":"post","link":"https:\/\/www.sbglaucoma.org.br\/medico\/iridotomia-na-sindrome-de-dispersao-pigmentar-estudo-clinico-randomizado\/","title":{"rendered":"IRIDOTOMIA NA SINDROME DE DISPERSAO PIGMENTAR \u2013 ESTUDO CLINICO RANDOMIZADO"},"content":{"rendered":"
\n
A\"\"rtigo comentado por:<\/strong>
\nDr. Fl\u00e1vio Lopes, m\u00e9dico-oftalmologista,
\nfellow do 2o ano do Servi\u00e7o de Glaucoma, Departamento de Oftalmologia e
\nCi\u00eancias Visuais, EPM-HSP-UNIFESP.
\nStefano A. Gandolfi, MD; Nicola Ungaro, MD; Maria Grazia Tardini, AO; Stella Ghirardini,
\nAO; Arturo Carta, MD; Paolo Mora, MD<\/p>\n

JAMA Ophthalmol. doi:10.1001\/jamaophthalmol.2014.3291<\/p>\n

. Published online September 4, 2014.
\n<\/span><\/div>\n

\"\"Editor Associado<\/strong>
\nProf.Dr. Ivan Maynart Tavares<\/strong>
\n<\/span><\/div>\n<\/div>\n

A s\u00edndrome de dispers\u00e3o pigmentar (SDP) \u00e9 uma condi\u00e7\u00e3o que ocorre quando a m\u00e9dia periferia da \u00edris, ao manter contato com a z\u00f4nula, causa a libera\u00e7\u00e3o de pigmentos presentes no neuroepit\u00e9lio pigmentado da \u00edris. Dessa forma, ao exame de biomicroscopia, podem-se observar defeitos irianos, por transilumina\u00e7\u00e3o, e deposi\u00e7\u00e3o de pigmentos no endot\u00e9lio corneano, o fuso de Krukenberg, sinais caracter\u00edsticos da s\u00edndrome.
\nAp\u00f3s serem liberados, os pigmentos seguem o fluxo do humor aquoso e s\u00e3o depositados em estruturas da c\u00e2mara anterior, como endot\u00e9lio corneano, c\u00e1psula anterior do cristalino e tamb\u00e9m na malha trabecular. A preval\u00eancia da SDP \u00e9 de aproximadamente 2,5% e a taxa de convers\u00e3o para glaucoma pigmentar \u00e9 controversa. Sendo assim, em um ensaio cl\u00ednico randomizado de 10 anos, Gandolfi e colaboradores analisaram o efeito da iridotomia a laser na hist\u00f3ria natural da s\u00edndrome de dispers\u00e3o pigmentar.
\nOs autores propuseram utilizar um teste com col\u00edrio de fenilefrina 10%, visando separar os pacientes com SDP em alto ou baixo risco de apresentarem aumento da press\u00e3o intraocular (PIO). Os pacientes classificados como de alto risco eram submetidos \u00e0 iridotomia com Nd:YAG laser em apenas um olho; nenhum paciente de baixo risco foi tratado. O grupo controle foi composto por olhos de pacientes de baixo risco e os olhos contralaterais n\u00e3o tratados dos pacientes de alto risco. Um aumento \u22655 mmHg da PIO basal foi considerado como significante. Por\u00e9m, \u00e9 fundamental se ater \u00e0 indica\u00e7\u00e3o em casos espec\u00edficos, isto \u00e9, aqueles de alto risco, de acordo com o estudo, e com concavidade aumentada da \u00edris; e ter em mente os riscos da iridotomia a laser, que, apesar de baixos, existem, especialmente nos casos em que h\u00e1 altera\u00e7\u00f5es da periferia retiniana, mais comuns nessa s\u00edndrome, com consequente risco aumentado de descolamento de retina.<\/span>
\nNo grupo de alto risco submetidos a iridotomia (n=16 olhos), tr\u00eas olhos apresentaram aumento \u22655 mmHg da PIO basal. No grupo de alto risco n\u00e3o tratados (n=16 olhos), 13 olhos apresentaram o aumento; j\u00e1 no grupo de baixo risco (n= 30 olhos), foram quatro olhos. Com isso, foi verificado que, em 10 anos de seguimento, a taxa do evento (aumento \u22655 mmHg da PIO basal) em olhos que n\u00e3o fizeram iridotomia foi de 30,4%<\/strong>. Considerando apenas os olhos de alto risco n\u00e3o tratados, mais de 60% tiveram o aumento da PIO. A m\u00e9dia de tempo durante o qual os olhos ficaram livre do evento (sobreviv\u00eancia) foi, aproximadamente, de oito anos para olhos de alto risco tratados; quatro anos para olhos de alto risco n\u00e3o tratados e sete anos para olhos de baixo risco.
\nApesar do pequeno n\u00famero de olhos analisados, os autores observaram que aproximadamente um ter\u00e7o de todos os pacientes com SDP apresentou um aumento \u22655 mmHg da PIO em pelo menos um olho<\/strong>. Portanto, a presen\u00e7a de dispers\u00e3o de pigmento ap\u00f3s midr\u00edase medicamentosa poderia ajudar na identifica\u00e7\u00e3o de quais pacientes com SDP possuiriam alto risco para desenvolver hipertens\u00e3o ocular. Por fim, a iridotomia, quando realizada em olhos de alto risco, reduziu a taxa de eleva\u00e7\u00e3o da PIO para o mesmo n\u00edvel que olhos de baixo risco.<\/p>\n

Finalmente, Stefano Gandolfi e colaboradores nos apresentam, por meio de um estudo elegante, evid\u00eancia adequada para um procedimento at\u00e9 h\u00e1 pouco com efic\u00e1cia e seguran\u00e7a questionadas: a iridotomia a laser na s\u00edndrome de dispers\u00e3o pigmentar. Por\u00e9m, \u00e9 fundamental se ater \u00e0 indica\u00e7\u00e3o em casos espec\u00edficos, isto \u00e9, aqueles de alto risco, de acordo com o estudo, e com concavidade aumentada da \u00edris; e ter em mente os riscos da iridotomia a laser, que, apesar de baixos, existem, especialmente nos casos em que h\u00e1 altera\u00e7\u00f5es da periferia retiniana, mais comuns nessa s\u00edndrome, com consequente risco aumentado de descolamento de retina.<\/p>\n

\n
\n

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

\nJAMA Ophthalmol<\/em>. 2014 Sep 4. doi: 10.1001\/jamaophthalmol.2014.3291. [Epub ahead of print]
\nA 10-Year Follow-up to Determine the Effect of YAG Laser Iridotomy on the Natural History of Pigment Dispersion Syndrome: A Randomized Clinical Trial<\/strong>.
\nGandolfi SA, Ungaro N, Tardini MG, Ghirardini S, Carta A, Mora P.
\nAuthor information<\/strong><\/p>\n

Abstract<\/strong>
\nIMPORTANCE<\/strong>:
\nProspective long-term analyses of the role of drug-induced mydriasis and laser peripheral iridotomy (LPI) are needed to identify and manage the eyes of patients with pigment dispersion syndrome (PDS) at risk for progressing to ocular hypertension.<\/p>\n

OBJECTIVE<\/strong>:
\nTo assess the 10-year incidence of increased intraocular pressure (IOP) in the 2 eyes of patients with PDS, with 1 eye that underwent LPI and the other that did not.<\/p>\n

DESIGN, SETTING, AND PARTICIPANTS<\/strong>:
\nIn a randomized clinical trial in the glaucoma research unit at the University Hospital of Parma, Italy, 72 patients with PDS underwent phenylephrine testing. Of these 72 patients, 29 (58 eyes) tested positive for succeeding IOP elevation, and 43 (59 eyes) tested negative. For the 29 high-risk patients (all in both eyes), one eye was randomly assigned to LPI, and the fellow eye was left untreated. For the 43 low-risk patients, the affected eyes were left untreated.<\/p>\n

MAIN OUTCOMES AND MEASURES<\/strong>:
\nAn IOP elevation of 5 mm Hg or higher vs baseline (daily phasing) was considered to be a significant increase (ie, an event).<\/p>\n

RESULTS<\/strong>:
\nIn the high-risk group, 3 of 21 eyes that underwent LPI (14.3%) and 13 of 21 untreated eyes (61.9%) showed an increase in IOP of 5 mm Hg or higher during the follow-up period; 4 of 35 low-risk eyes (11.4%) showed a similar increase. Event-free mean (SD) time was 7.99 (0.43) years for high-risk treated eyes, 3.89 (0.68) years for high-risk untreated eyes, and 7.16 (0.23) years for low-risk eyes. The log-rank test showed the following: P\u2009<\u2009.001 for treated high-risk eyes vs untreated high-risk eyes, P\u2009=\u2009.74 for treated high-risk eyes vs low-risk eyes, and P\u2009<\u2009.001 for untreated high-risk eyes vs low-risk eyes.<\/p>\n

CONCLUSIONS AND RELEVANCE<\/strong>:
\nAt the end of the 10-year follow-up, (1) approximately one-third of the whole PDS patient population showed an IOP increase of 5 mm Hg or higher in at least 1 eye; (2) phenylephrine testing identified eyes at high risk for developing IOP elevation; and (3) LPI, when performed on high-risk eyes, reduced the rate of IOP elevation to the same level as the low-risk eyes.<\/p>\n<\/p><\/div>\n<\/p><\/div>\n<\/p><\/div>\n<\/p><\/div>\n<\/p><\/div>\n<\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"

Artigo comentado por: Dr. Fl\u00e1vio Lopes, m\u00e9dico-oftalmologista, fellow do 2o ano do Servi\u00e7o de Glaucoma, Departamento de Oftalmologia e Ci\u00eancias Visuais, EPM-HSP-UNIFESP. Stefano A. Gandolfi, MD; Nicola Ungaro, MD; Maria Grazia Tardini, AO; Stella Ghirardini, AO; Arturo Carta, MD; Paolo Mora, MD JAMA Ophthalmol. doi:10.1001\/jamaophthalmol.2014.3291 . Published online September 4, 2014. Editor Associado Prof.Dr. Ivan […]<\/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-361","post","type-post","status-publish","format-standard","hentry","category-sem-categoria"],"acf":[],"yoast_head":"\nIRIDOTOMIA NA SINDROME DE DISPERSAO PIGMENTAR \u2013 ESTUDO CLINICO RANDOMIZADO - 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\/iridotomia-na-sindrome-de-dispersao-pigmentar-estudo-clinico-randomizado\/\" \/>\n<meta property=\"og:locale\" content=\"pt_BR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"IRIDOTOMIA NA SINDROME DE DISPERSAO PIGMENTAR \u2013 ESTUDO CLINICO RANDOMIZADO - SBG - Sociedade Brasileira de Glaucoma\" \/>\n<meta property=\"og:description\" content=\"Artigo comentado por: Dr. Fl\u00e1vio Lopes, m\u00e9dico-oftalmologista, fellow do 2o ano do Servi\u00e7o de Glaucoma, Departamento de Oftalmologia e Ci\u00eancias Visuais, EPM-HSP-UNIFESP. Stefano A. Gandolfi, MD; Nicola Ungaro, MD; Maria Grazia Tardini, AO; Stella Ghirardini, AO; Arturo Carta, MD; Paolo Mora, MD JAMA Ophthalmol. doi:10.1001\/jamaophthalmol.2014.3291 . Published online September 4, 2014. 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Stefano A. Gandolfi, MD; Nicola Ungaro, MD; Maria Grazia Tardini, AO; Stella Ghirardini, AO; Arturo Carta, MD; Paolo Mora, MD JAMA Ophthalmol. doi:10.1001\/jamaophthalmol.2014.3291 . Published online September 4, 2014. 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