{"id":4415,"date":"2016-11-25T15:20:09","date_gmt":"2016-11-25T17:20:09","guid":{"rendered":"https:\/\/sbglaucoma2.websiteseguro.com\/medico\/?p=4415"},"modified":"2019-06-11T12:25:28","modified_gmt":"2019-06-11T15:25:28","slug":"central-glaucomatous-damage","status":"publish","type":"post","link":"https:\/\/www.sbglaucoma.org.br\/medico\/central-glaucomatous-damage\/","title":{"rendered":"Central Glaucomatous Damage"},"content":{"rendered":"

Central Glaucomatous Damage of the Macula Can Be Overlooked by conventional OCT Retinal Nerve Fiber Layer Thickness Analyses<\/h3>\n
\n
\"\"Julia C.H. Cardoso<\/strong>
Assistente do Departamento de Glaucoma do IOCM<\/p>\n<\/div>\n
Fabio N. Kanadani<\/strong>
Chefe da Oftalmologia do IOCM, Doutor pela UNIFESP<\/p>\n

<\/span>\n<\/div>\n<\/div>\n

Ref.: Central Glaucomatous Damage of the Macula Can Be Overlooked by conventional OCT Retinal Nerve Fiber Layer Thickness Analyses<\/strong>.
\nDiane L. Wang, Ali S. Raza, Carlos Gustavo de Moraes, Monica Chen,
\nPaula Alhadeff, Ravivarn Jarukatsetphorn, Robert Ritch, and Donald C. Hood.
\nTrans Vis Sci Tech. 2015;4(6):4,<\/p>\n

 <\/p>\n

Existe sempre um questionamento da capacidade diagn\u00f3stica do glaucoma em uma avalia\u00e7\u00e3o da regi\u00e3o macular pela tomografia de coer\u00eancia \u00f3ptica (OCT). Muitos acreditam que defeitos maculares ocorrem logo no in\u00edcio da doen\u00e7a e pode ser mais comum do que o descrito na literatura. Este defeito pode ser local, arqueado, difuso ou um combina\u00e7\u00e3o destes. Mesmo assim, a avalia\u00e7\u00e3o macular geralmente n\u00e3o faz parte da rotina cl\u00ednica de muitos especialistas em glaucoma. <\/p>\n

Alguns estudos descrevem que uma avalia\u00e7\u00e3o macular n\u00e3o \u00e9 melhor que a avalia\u00e7\u00e3o da camada de fibras nervosas da retina (CFNR) peripapilar, mas muitos n\u00e3o levam em considera\u00e7\u00e3o os protocolos espec\u00edficos de avalia\u00e7\u00e3o desta regi\u00e3o. Al\u00e9m disto, muitos destes estudos descrevem como crit\u00e9rios de inclus\u00e3o campos visuais 30-2 ou 24-2 (com dist\u00e2ncia de 6 graus entre os pontos testados), testes que podem deixar de detectar reais danos centrais, por vezes detectados apenas no 10-2 (com menor dist\u00e2ncia – de 2 graus – entre os pontos testados). A regi\u00e3o inferior da m\u00e1cula est\u00e1 diretamente relacionada com fibras nervosas do p\u00f3lo inferior do disco \u00f3ptico, e ambos os locais s\u00e3o muito suscept\u00edveis ao dano glaucomatoso; assim, a avalia\u00e7\u00e3o de poss\u00edveis defeitos maculares torna-se t\u00e3o importante. <\/p>\n

Este estudo tem como objetivo avaliar a extens\u00e3o do dano glaucomatoso macular que poderia ser detectado usando o pacote estat\u00edstico dispon\u00edvel comercialmente obtido pelo fdOCT (frequency domain optical coherence tomography- 3D-OCT 2000; Topcon, Inc., Oakland, NJ).
\n
\nEnfim, apesar de ainda n\u00e3o ser uma pr\u00e1tica rotineira, a avalia\u00e7\u00e3o da regi\u00e3o macular pela OCT pode trazer informa\u00e7\u00f5es \u00fateis ao diagn\u00f3stico e acompanhamento do glaucoma, al\u00e9m da possibilidade de diagn\u00f3stico de outras doen\u00e7as que acometem esta regi\u00e3o.
\n<\/span>
\nNo presente estudo, cento e quarenta e tr\u00eas olhos glaucomatosos e suspeitos de glaucoma foram avaliados com o campo visual 10-2 e com scans em cubos da macula e discos \u00f3pticos no fdOCT. A an\u00e1lise dos relat\u00f3rios do fdOCT foi realizada pelos autores seguindo crit\u00e9rios que levaram em considera\u00e7\u00e3o a regi\u00e3o temporal inferior do disco \u00f3ptico, conhecida como \u201dZona Macular Vulner\u00e1vel\u201d , e que situa-se entre -38 e -65 graus, onde 0 grau corresponde ao centro do quadrante temporal .<\/p>\n

De modo peculiar, os autores descreveram alguns crit\u00e9rios de an\u00e1lise macular, baseados no quadrante temporal (QT) total, QT + 7 horas e QT + 7-10 horas. <\/p>\n

Do total de 143 olhos, sessenta e um olhos (43%) foram classificados como \u201cmacula anormal\u201d, enquanto 41 olhos (29%) como \u201cm\u00e1cula normal\u201d. O campo visual 10-2 e os mapas de probabilidade do OCT n\u00e3o concordaram nos demais olhos. Dos 61 olhos anormais, os crit\u00e9rios falharam em diagnosticar o defeito de 36 a 77% dos casos, sendo 77%, 39% e 36% para o QT, QT+7 horas e QT +7-10 horas, respectivamente. <\/p>\n

O padr\u00e3o mais encontrado nestes olhos onde a avalia\u00e7\u00e3o da CFNR peripapilar n\u00e3o identificou um defeito segundo os crit\u00e9rios acima descritos foi um defeito estrutural sutil na m\u00e1cula, seguido por um defeito arqueado macular. <\/p>\n

A an\u00e1lise da CFNR peripapilar no OCT comercialmente dispon\u00edvel pode deixar de identificar defeitos maculares em parte significativa dos pacientes, especialmente se a an\u00e1lise \u00e9 feita de modo global. <\/strong><\/p>\n

Deste modo, em defeitos glaucomatosos maculares outros protocolos (cube scans) ou campos visuais 10-2 devem ser realizados. <\/p>\n

Enfim, apesar de ainda n\u00e3o ser uma pr\u00e1tica rotineira, a avalia\u00e7\u00e3o da regi\u00e3o macular pela OCT pode trazer informa\u00e7\u00f5es \u00fateis ao diagn\u00f3stico e acompanhamento do glaucoma, al\u00e9m da possibilidade de diagn\u00f3stico de outras doen\u00e7as que acometem esta regi\u00e3o.<\/p>\n

Na pr\u00e1tica cl\u00ednica, \u00e9 importante considerar a regi\u00e3o localizada `as 7hs da CFNR peripapilar, que \u00e9 a mais associada a este dano macular e defeitos no campo visual 10-2. <\/p>\n","protected":false},"excerpt":{"rendered":"

Central Glaucomatous Damage of the Macula Can Be Overlooked by conventional OCT Retinal Nerve Fiber Layer Thickness Analyses Julia C.H. Cardoso Assistente do Departamento de Glaucoma do IOCM Fabio N. KanadaniChefe da Oftalmologia do IOCM, Doutor pela UNIFESP Ref.: Central Glaucomatous Damage of the Macula Can Be Overlooked by conventional OCT Retinal Nerve Fiber Layer […]<\/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-4415","post","type-post","status-publish","format-standard","hentry","category-sem-categoria"],"acf":[],"yoast_head":"\nCentral Glaucomatous Damage - 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\/central-glaucomatous-damage\/\" \/>\n<meta property=\"og:locale\" content=\"pt_BR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Central Glaucomatous Damage - SBG - Sociedade Brasileira de Glaucoma\" \/>\n<meta property=\"og:description\" content=\"Central Glaucomatous Damage of the Macula Can Be Overlooked by conventional OCT Retinal Nerve Fiber Layer Thickness Analyses Julia C.H. 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