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An investigation of some biochemical and cellular properties of subretnal fluids.January 1994 (has links)
by Xu Xun. / Thesis (M.Phil.)--Chinese University of Hong Kong, 1994. / Includes bibliographical references (leaves 78-87). / Chapter CHAPTER 1 --- INTRODUCTION --- p.1 / Chapter CHAPTER 2 --- LITERATURE REVIEW --- p.6 / Chapter 2.1 --- Anatomy of retina and vitreous --- p.6 / Chapter 2.2 --- Rhegmatogenous retinal detachment --- p.8 / Chapter 2.2.1 --- Retinal breaks --- p.8 / Chapter 2.2.2 --- Retinal detachment and subretinal fluid --- p.8 / Chapter 2.3 --- Proliferative vitreoretinopathy --- p.9 / Chapter 2.4 --- Total protein in subretinal fluid --- p.11 / Chapter 2.5 --- Fibroblast growth factor --- p.12 / Chapter 2.5.1 --- Structure of b and a FGF and their gene --- p.13 / Chapter 2.5.2 --- Expression of bFGF and aFGF in neuroretinal and pigment epithelial cells --- p.14 / Chapter 2.5.3 --- The FGF receptors --- p.15 / Chapter 2.5.4 --- In vitro biological effect of FGF --- p.15 / Chapter 2.5.5 --- FGF in retinal diseases --- p.16 / Chapter 2.6 --- Cellular study of proliferative vitreoretinopathy --- p.18 / Chapter 2.6.1 --- Experimental study --- p.18 / Chapter 2.6.2 --- Pathogenesis of intravitreal proliferation --- p.20 / Chapter 2.6.3 --- Cellular components of proliferative tissue --- p.20 / Chapter 2.6.4 --- Cellular components of subretinal fluid --- p.22 / Chapter CHAPTER 3 --- MATERIALS AND METHODS --- p.24 / Chapter 3.1 --- Specimens --- p.24 / Chapter 3.2 --- Determination of total protein --- p.24 / Chapter 3.2.1 --- Study population --- p.24 / Chapter 3.2.2 --- Quantitation of total protein --- p.25 / Chapter 3.3 --- Determination of bFGF --- p.27 / Chapter 3.3.1 --- Study population --- p.27 / Chapter 3.3.2 --- Quantitation of bFGF --- p.28 / Chapter 3.4 --- Celular study --- p.30 / Chapter 3.4.1 --- Study population --- p.30 / Chapter 3.4.2 --- Fixation of samples --- p.30 / Chapter 3.4.3 --- Immunocytology --- p.32 / Chapter 3.4.4 --- Examination of autofluorescence --- p.35 / Chapter 3.4.5 --- Hematoxylin and eosin staining --- p.36 / Chapter CHAPTER 4 --- RESULTS --- p.37 / Chapter 4.1 --- Total protein --- p.37 / Chapter 4.1.2 --- Total protein in subretinal fluids --- p.38 / Chapter 4.1.3 --- Total protein in normal vitreous of autopsy and sera of patients --- p.40 / Chapter 4.1.4 --- Relationship of protein level and size of retinal break --- p.40 / Chapter 4.1.5 --- Relationship of protein level and duration of retinal detachment --- p.43 / Chapter 4.1.6 --- Relationship of protein level and degree of PVR --- p.45 / Chapter 4.2 --- Basic FGF in subretinal fluids --- p.47 / Chapter 4.2.1 --- Standard curve for determination of bFGF in SRF --- p.47 / Chapter 4.2.2 --- The levels of bFGF in both SRF and controls --- p.48 / Chapter 4.2.3 --- Levels of bFGF in different degrees of PVR --- p.50 / Chapter 4.2.4 --- Levels of bFGF in SRF of RD with and without previous cryotherapy --- p.54 / Chapter 4.2.5 --- The relationship of level of protein and bFGF --- p.55 / Chapter 4.3 --- Results of cytological examination --- p.57 / Chapter 4.3.1 --- Pigment examingnation by autofluorescence --- p.57 / Chapter 4.3.2 --- Cellular study of subretinal fluids --- p.59 / Chapter 4.3.3 --- Cellular study of subretinal fluid in eyes with prior cryotherapy --- p.62 / Chapter CHAPTER 5 --- DISCUSSION --- p.68 / Chapter 5.1 --- Evaluaton of method for obtaining specimens --- p.68 / Chapter 5.2 --- Total protein of SRF in retinal detachment --- p.69 / Chapter 5.3 --- Basic FGF in subretinal fluids --- p.71 / Chapter 5.4 --- Elevated level of bFGF in eye after cryotherapy --- p.74 / Chapter 5.5 --- Cell components in SRF of PVR --- p.75 / REFERENCES --- p.78
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Investigation of Perforated Ducted Propellers to use with a UAVRegmi, Krishna 01 May 2013 (has links)
Unmanned Aerial Vehicle (UAV) is any flying vehicle which is not controlled by actual human pilots sitting in the cockpit but is installed with proper avionics that can either fly autonomously or by using the commands from its base. Some rotorcraft UAVs use a ducted propeller for two main reasons- safety and to increase the thrust produced by the propellers. While ducted rotors can increase the thrust produced, it also adds weight to the UAV. It was therefore hypothesized that by removing part of the duct materials (i.e. adding perforations in the duct) would benefit from both decreased duct weight and increased thrust. However, it is not clear how much trade-off would be between these two factors. Hence, the objective of this study is to explore the relationship between the change of thrust and addition of different numbers or sizes of perforations. Cases with and without duct, and duct with perforations were simulated using a commercial computational fluid dynamic (CFD) software Ansys/Fluent. The physics of the rotating propeller was modeled by a simplified disc with a pressure jump across an infinitesimal volume. Three different RPM speeds of the propellers were simulated by varying the strength of the pressure jump. The results show that the thrust decreases as the duct is added. As perforations are added, the result shows that with more perforations (i.e. more open area on the duct wall), the thrust increases accordingly until the thrust reaches a maximum value without the duct. The result is in contrast to a published experimental data stating that installation of duct can increase thrust. It is speculated that the current duct with a flat wall has caused such difference from the experimental data. Further study is recommended to continue more detailed computational simulation using a duct with cambered airfoil configuration to reduce the aerodynamic losses.
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Homogénéisation et simulation numérique de structures piézoélectriques perforées et laminéesMECHKOUR, Houari 19 November 2004 (has links) (PDF)
Cette thèse est consacrée à l'étude asymptotique et l'homogénéisation de l'équation de la piézoélectricité, dans le cas de coefficients rapidement oscillants et des structures périodiquement perforées. L'étude consiste à développer deux approches; théorique et numérique. <br /><br />Dans l'approche théorique, on établit le problème homogénéisé et les tenseurs effectifs, ainsi que leurs propriétés pour une structure tridimensionnelle perforée, quand la période tend vers zéro. En se basant sur la même méthodologie, on traite le cas d'une plaque mince et d'une coque de Koiter périodiques, lorsque l'épaisseur et la période tendent vers zéro.<br /><br />Le deuxième volet comporte la simulation numérique du comportement macroscopique de quelques structures piézoélectriques particulières, en l'occurrence : le piézocomposite perforé et le piézocomposite laminé. Cette simulation trouve un intérêt pour de nouvelles applications dans ce type de structures, notamment l'hydrophonie, l'imagerie biomédicale et le contrôle des vibrations (filtrage spatial).
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Plasminogen : a novel inflammatory regulator that promotes wound healingShen, Yue January 2013 (has links)
The plasminogen activator (PA) system has been shown to be intimately involved in wound healing. However, the role of this system in the initiation and resolution of inflammation during healing process remained to be determined. The aims of this thesis were to investigate the molecular mechanism underlying the interaction between the PA system and the inflammatory system during wound healing and to explore the therapeutic potential of plasminogen in various wound-healing models. The role of plasminogen in the inflammatory phase of the healing process of acute and diabetic wounds was studied first. Our data showed that administration of additional plasminogen to wild-type mice accelerates the healing of acute wounds. After injury, both endogenous and exogenous plasminogen are bound to inflammatory cells and are transported to the wound site, which leads to activation of inflammatory cells. In diabetic db/db mice, wound-specific accumulation of plasminogen does not take place and the inflammatory response is impaired. However, when additional plasminogen is injected, plasminogen accumulates in the wound, the inflammatory response is enhanced, the signal transduction cascade is activated and the healing rate is significantly increased. These results indicate that administration of plasminogen may be a novel therapeutic strategy to treat different types of wounds, especially chronic wounds in diabetes. The role of plasminogen at the later stage of wound healing was also studied in plasminogen-deficient mice. Our data showed that even if re-epithelialization is achieved in these mice, a prolonged inflammatory phase with abundant neutrophil accumulation and persistent fibrin deposition is observed at the wound site. These results indicate that plasminogen is also essential for the later phases of wound healing by clearing fibrin and resolving inflammation. The functional role of two physiological PAs during wound healing was further studied in a tympanic membrane (TM) wound-healing model. Our data showed that the healing process was clearly delayed in urokinase-type PA (uPA)-deficient mice but not in tissue-type PA (tPA)-deficient mice. Less pronounced keratinocyte migration, abundant neutrophil accumulation and persistent fibrin deposition were observed in uPA-deficient mice. These results indicate that uPA plays a central role in the generation of plasmin during the healing of TM perforations. Finally the therapeutic potential of plasminogen in the TM wound-healing model was studied. Our data showed that local injection of plasminogen restores the ability to heal TM perforations in plasminogen-deficient mice in a dose-dependent manner. Plasminogen supplementation also potentiates healing of acute TM perforations in wild-type mice, independent of the administration method used. A single local injection of plasminogen in plasminogen-deficient mice can initiate healing of chronic TM perforations resulting in a closed TM with a continuous but rather thick outer keratinocyte layer. Three plasminogen injections lead to a completely healed TM with a thin keratinizing squamous epithelium covering a connective tissue layer that can start to reorganize and further mature to its normal appearance. In conclusion, our results suggest that plasminogen is a promising drug candidate for the treatment of chronic TM perforations in humans. Taken together, our data indicate that plasminogen is a novel inflammatory regulator that promotes wound healing.
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Composites périodiques fonctionnels pour l'absorption vibroacoustique large bande / Periodics composites for vibroacoustic wideband absorptionBillon, Kevin 22 November 2016 (has links)
Ces travaux de thèse sont consacrés à l’analyse des phénomènes ondulatoires se produisant dans les structures périodiques : des phénomènes comme les réflexions de Bragg ou les résonances locales qui émergent dans de telles structures permettent de contrôler la propagation des ondes, et ces structures présentent donc des propriétés spécifiques. Dans le premier chapitre, des outils numériques permettant de déterminer les relations de dispersion dans les structures périodiques sont présentées, et notamment la méthode de Floquet-Bloch qui sert de référence dans l’analyse des milieux périodiques. Cette technique consiste à résoudre le problème sur une cellule unitaire avec des conditions limites adaptées, cependant l’introduction d’amortissement dans les cas 2D et 3D n’est pas facile. Elle est mise en œuvre dans le deuxième chapitre pour étudier la propagation des ondes dans un méta matériau comprenant des performations rectangulaires, hiérarchiques et auxétiques (coefficient de poisson négatif). L’influence des paramètres géométriques de la cellule sur la dispersion et les propriétés mécaniques de la structure est investiguée en utilisant une méthode d’homogénéisation. Une validation expérimentale est effectuée sur un réseau en polyméthacrylate de méthyle (PMMA) en utilisant un vibromètre3d à balayage. Dans le troisième chapitre, une alternative à la méthode de Floquet-Bloch pour étudier la propagation d’ondes dans des milieux dissipatifs est décrite : la méthode intitulée « Shift cell operator ». Elle est basée sur une reformulation du problème aux équations aux dérivés partielles, la périodicité étant incluse dans le comportement global de la structure et des conditions de continuité sur les bords de la cellule sont imposés. Cette stratégie permet de résoudre le problème quelle que soit l’évolution en fréquence de propriétés de la cellule. Des outils de post-traitement des diagrammes de dispersion avec amortissement sont proposés basés notamment sur une analyse de la vitesse de groupe. Dans le dernier chapitre, la démarche est appliquées sur une structure périodique amortie consistant en un guide d’ondes bidirectionnel infini mêlant aluminium et polymère hautement dissipatif. Les résultats obtenus sur une structure finie intégrant une interface composée d’un ensemble distribué de ces cellules unitaires confirment le caractère adaptatif du méta matériau ainsi conçu. Une confrontation de ces résultats à des résultats expérimentaux a permis de confirmer ce comportement. / The understanding of wave propagation in periodic structures is proposed in this work. Periodic structures exhibit very specific properties in terms of wave propagation. First, some numerical tools for dispersion analysis of periodic structures are presented. The classical Floquet-Bloch approach is first presented, as a reference. This technique uses proper boundary conditions on the unit cell, but dealing with damping is not easy for 2D or 3D cases. Secondly, a metamaterial with hierarchical, auxetic (negative Poisson ratio) rectangular perforations is presented using the Floquet-Bloch method as a reference. Some numerical eigenvalue tools are used for the dispersion analysis of this structure. A geometric parametric investigation of these rectangular perforations using a numerical asymptotic homogenisation finite element approach is done. The experimental validation is performed with a network based on polymethyl methacrylate (PMMA) using a 3D scanning vibrometer. Third, the Shift cell operator technique is described. It consists in a reformulation of the PDE problem by shifting in terms of wave number the space derivatives appearing in the mechanical behavior operator inside the cell, while imposing continuity boundary conditions on the borders of the domain. Damping effects can be introduced in the system. This strategy make it possible to solve the problem with an arbitrary frequency dependency of the physical properties of the cell. A focus is proposed on tools for the post-processing of dispersion diagrams in damped configurations like group velocity. Finally, an adaptive metamaterial based on the combination of metallic parts with highly dissipative polymeric interface is designed. In order to validate the design and the adaptive character of the metamaterial, results issued from a full 3D model of a finite structure embedding an interface composed by a distributed set of the unit cells are presented. After this step, a comparison between the results obtained using the tunable structure simulation and the experimental results is presented.
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Étude acoustique des matériaux poreux à cellules ferméesChevillotte, Fabien January 2008 (has links)
Les travaux présentés dans ce document concernent les mousses à cellules fermées. Deux axes sont développés. Le premier axe de recherche est focalisé sur l'amélioration des performances d'absorption sonore des mousses métalliques à cellules fermées et plus particulièrement des mousses d'aluminium. Les deux principales méthodes post-fabrication sont étudiées par une approche microstructurale. Une approche microstructurale consiste à étudier la géométrie locale afin de prédire les propriétés macroscopiques des matériaux. La première approche consiste à compresser les mousses afin de fracturer les parois des pores. La seconde approche consiste à perforer les mousses. La conclusion est que la méthode des fissurations est plus performante que la méthode des perforations. Cette méthode permet d'obtenir une absorption sonore large bande alors que la méthode des perforations augmente l'absorption de manière sélective. Du fait que l'approche microstructurale a été étendue aux mousses à cellules ouvertes afin de comprendre l'influence des paramètres microstructuraux, l'influence de la taille des étranglements, de la taille des pores et de la forme des sections de ligaments est analysée. Les résultats permettent maintenant de conseiller les manufacturiers de mousses afin de prendre en compte la composante acoustique des mousses dès leur fabrication. C'est une approche préfabrication. Le second axe de recherche concerne les mousses à cellules fermées et à structure souple. L'absence d'effets visqueux permet de modéliser ce type de mousse par un solide élastique équivalent. Il est alors possible d'établir une caractérisation des propriétés élastiques par une méthode inverse acoustique. La méthode permet de déterminer les propriétés élastiques du matériau à partir de simples mesures d'absorption en tube d'impédance. La méthode est développée pour deux conditions de montage. La condition glissante est délicate à assurer mais elle permet de développer une méthode simple. La méthode est ensuite étendue à des échantillons encastrés." Les travaux concernant la caractérisation ont donné lieu à un article et deux actes de conférence (Chevillotte et coll., Chapitre 3, 2007)4,5,6. Le modèle numérique et l'étude des microstructures ont également contribué à des publications et des actes de conférences (Perrot et coll., Annexes E, F et G, 2007--2008) 60,62,63,64.
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Estudo do buraco macular fechado cirurgicamente: avaliação da relação entre a integridade da camada de fotorreceptores e a acuidade visual final por meio da tomografia de coerência óptica / Optical coherence tomography evaluation of surgically closed macular holes: photoreceptor layer integrity analysis and its correlation with final visual outcomeGomes, André Marcelo Vieira 28 September 2007 (has links)
Introdução: O tratamento do buraco macular idiopático ainda é acompanhado de incertezas em relação ao seu prognóstico. Ao longo dos últimos anos, têm sido utilizados o tempo de história, o tamanho e a acuidade visual pré-operatória dos buracos como critérios de orientação quanto ao resultado visual final. O aspecto final da parte mais externa da retina foveal tem merecido especial atenção em relatos recentes. Neste trabalho, avaliou-se, por meio da tomografia de coerência óptica, a integridade da camada de fotorreceptores, correlacionando o seu aspecto final com a acuidade visual obtida em casos de buraco macular idiopático, fechados cirurgicamente. Métodos: Pacientes operados com sucesso e com seguimento mínimo de 12 meses foram submetidos à avaliação oftalmológica completa incluindo a medida da acuidade visual final em escala logMar, biomicroscopia de mácula, oftalmoscopia indireta e angiofluoresceinografia. Colheram-se dados sobre idade, sexo, raça, tempo de história e tamanho do buraco além da acuidade visual pré-operatória. Para a classificação das lesões, utilizaram-se os critérios definidos por Gass. Imagens tomográficas da camada correspondente aos fotorreceptores da retina na região foveal foram criteriosamente obtidas através da tomografia de coerência óptica. Uma avaliação qualitativa desta camada foi realizada por examinador experiente, de forma mascarada, com os pacientes então classificados em três grupos (1, 2 e 3), em ordem crescente de integridade. Resultados: Foram incluídos no estudo 39 olhos de 37 pacientes, sendo eles 22 mulheres (59,5%) e 15 homens (40,5%). A idade média foi de 68,2 anos variando entre 51 e 83 anos. O tempo de seguimento pós-operatório médio foi de 38,5 meses. Entre todos os olhos estudados, 12 foram incluídos no grupo 1 (menor integridade); sete, no grupo 2 e vinte, no grupo 3. Na comparação entre os grupos 1 e 3, a acuidade visual final melhorou em ambos; porém, com maior intensidade no grupo 3 (p<0,001). O tamanho pré-operatório do buraco e o tempo de história da doença não impactaram significativamente o resultado visual final (p=0,223 e p=0,559, respectivamente). A acuidade visual pré-operatória média foi maior no grupo 3 que no grupo 1 (p=0,012). Conclusões: Os dados obtidos através deste estudo sugerem correlação entre uma maior integridade da camada dos fotorreceptores e um melhor resultado visual de longo prazo, em pacientes com buraco macular idiopático, operados com sucesso. Embora a visão tenha melhorado em todos os grupos, a melhora foi significativamente maior no grupo 3 que no grupo 1. Em relação ao tamanho pré-operatório da lesão e o tempo de história da doença, não se observou impacto significativo no resultado. Uma melhor acuidade visual inicial pré-operatória pode influenciar positivamente a acuidade visual final. / Purpose: To evaluate the integrity of the retina photoreceptor layer as determined by optical coherence tomography and its relationship with final visual outcome in successfully closed idiopathic macular holes. Methods: Successfully operated patients with a minimal follow-up of 12 months, underwent complete ophthalmic exam involving post-operative best corrected visual acuity using logMar scale, macula biomicroscopy and indirect ophthalmoscopy and fluorescein angiography. Complete epidemiologic data was collected as well as time duration, pre-op visual acuity, and size and Gass classification of the holes. Optical coherence tomography images of the layer corresponding to the transition between inner and outer segments of the photoreceptors were meticulously generated using commercially available Stratus OCT (OCT3). Qualitative analysis of this layer was carried out, in a masked fashion, by a certified and well experienced examiner. Based on increasing integrity showed in the images, patients were then distributed in 3 groups: 1, 2 and 3. Group 1 integrity from 1 to 33%, group 2 from 34 to 66%, and group 3 from 67 to 100%. Results: A total of 39 eyes of 37 patients were included in the study. Among all patients, 12 were included in group 1, 7 in group 3 and 20 in group 3. There were 22 female (59,5%) and 15 male (40,5%). Mean age was 68.2 years varying from 51 to 83 years of age. Mean post-op follow-up time was 38.5 months. When comparing groups 1 and 3, best corrected final visual acuity improved in both groups but dramatically in group 3 (better integrity) (p<0.001). Pre-operative size and time duration of the hole did not correlate with better visual acuity (p=0.223 and p=0.559 respectively). Mean pre-op visual acuity was better in group 3 than in group 1 (p=0.012). Conclusion: Data obtained in our study indicate that there is a strong correlation between better integrity of the photoreceptor layer, as determined by optical coherence tomography, and a more successful final, long term, visual acuity in patients with idiopathic macular hole successfully operated. Although final visual acuity has improved in all groups, there was statistical difference between groups 1 and 3. Pre-operative size and time duration of the hole did not have impact on final visual acuity. Better pre-op visual acuity may have an effect on final outcome.
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Morphogenesis of the early post-implantation mouse embryoKyprianou, Christos January 2019 (has links)
The morphogenetic events that give rise to the early post-implantation mouse embryo (egg cylinder) have not been thoroughly studied and our knowledge is restricted to "snap-shot" descriptions of embryos recovered at different stages of implantation from the mother. A central feature of the egg cylinder is the pro-amniotic cavity, which spans the embryo and participates in formation of the extraembryonic membranes. The major aims of my PhD studies have been to reveal how this cavity is formed (Aim 1) and then how the egg cylinder grows (Aim 2). In order to address how the pro-amniotic cavity forms (Aim 1), I first characterised in detail development of the architecture of the extra-embryonic ectoderm (ExE), which has to be remodelled to permit cavity formation. My findings indicate that the ExE comprises cells in direct contact with a basement membrane and cells that lie deeper in the tissue. The ExE originates in the polar trophectoderm, a monolayer covering the epiblast of the blastocyst, which expands and undergoes invagination to form a slit-like cavity. By carrying out analyses of fixed specimens and live imaging of cultured embryos, I have found that the epiblast and ExE cavity extend towards each other through the formation and resolution of multiple rosette structures. This leads to the fusion of the ExE and epiblast cavities to form the unified pro-amniotic cavity. I show that this process is dependent on signalling cues stemming from the underlying basement membrane that activate the b1-integrin signalling pathway to regulate cell polarity, ExE tissue architecture and rosette formation. In addition to the basement membrane's role in b1-integrin signalling, it also has physical functions that I characterise in the second part of my study (Aim 2). High resolution imaging revealed that the basement membrane underlying the epiblast is highly perforated during the implantation stages. These perforations are initially evenly distributed and then accumulate asymmetrically at the future posterior part of the embryo, just prior to gastrulation. Finally, I demonstrate that remodelling of the basement membrane requires the expression of matrix metalloproteinases (MMPs) in the epiblast under the control of Nodal. The anterior visceral endoderm inhibits Nodal signalling and hence MMP inhibition in the anterior. I demonstrate that activity of the MMPs and perforations in the basement membrane are essential for embryo growth. The domain of posterior basement membrane perforations persists beyond gastrulation suggesting a potential role for these perforations in primitive streak formation and extension. Together, my studies bring new important insights into the understanding of early mouse embryo morphogenesis.
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Retinal internal limiting membrane removal in macular hole surgery. / CUHK electronic theses & dissertations collectionJanuary 2003 (has links)
However, this is by no means the limit. More knowledge on macular hole is needed. Continuous research in Hong Kong and other scientific communities are indispensable. A multicentre, multi-surgeon study should be contemplated and carried out prior to the generalization or application of this technique to all patients. / Over the last few years, we have collected essential clinical and laboratory data on indocyanine green (ICG) assisted internal limiting membrane (ILM) peeling in macular hole surgery in Hong Kong. With the intraoperative use of a small volume and low concentration of ICG, we have shown the usefulness and safety of this technique in improving the surgical outcomes, both antomically and functionally, in patients with macular hole of idiopathic type or in severely myopic eyes. Our randomized controlled trial demonstrated higher anatomical closure rate and better visual outcome with ICG assisted ILM peeling compared with no ILM peeling in primary idiopathic macular hole surgery. Our case-control study also demonstrated that ICG assisted ILM removal in macular hole surgery of severely myopic eyes gives promising anatomical closure rate and visual outcome comparable to emmetropic ones. / Kwok Kwan-ho. / Source: Dissertation Abstracts International, Volume: 73-01, Section: B, page: . / Thesis (M.D.)--Chinese University of Hong Kong, 2003. / Includes bibliographical references (leaves 201-214). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [201-] System requirements: Adobe Acrobat Reader. Available via World Wide Web.
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Estudo do buraco macular fechado cirurgicamente: avaliação da relação entre a integridade da camada de fotorreceptores e a acuidade visual final por meio da tomografia de coerência óptica / Optical coherence tomography evaluation of surgically closed macular holes: photoreceptor layer integrity analysis and its correlation with final visual outcomeAndré Marcelo Vieira Gomes 28 September 2007 (has links)
Introdução: O tratamento do buraco macular idiopático ainda é acompanhado de incertezas em relação ao seu prognóstico. Ao longo dos últimos anos, têm sido utilizados o tempo de história, o tamanho e a acuidade visual pré-operatória dos buracos como critérios de orientação quanto ao resultado visual final. O aspecto final da parte mais externa da retina foveal tem merecido especial atenção em relatos recentes. Neste trabalho, avaliou-se, por meio da tomografia de coerência óptica, a integridade da camada de fotorreceptores, correlacionando o seu aspecto final com a acuidade visual obtida em casos de buraco macular idiopático, fechados cirurgicamente. Métodos: Pacientes operados com sucesso e com seguimento mínimo de 12 meses foram submetidos à avaliação oftalmológica completa incluindo a medida da acuidade visual final em escala logMar, biomicroscopia de mácula, oftalmoscopia indireta e angiofluoresceinografia. Colheram-se dados sobre idade, sexo, raça, tempo de história e tamanho do buraco além da acuidade visual pré-operatória. Para a classificação das lesões, utilizaram-se os critérios definidos por Gass. Imagens tomográficas da camada correspondente aos fotorreceptores da retina na região foveal foram criteriosamente obtidas através da tomografia de coerência óptica. Uma avaliação qualitativa desta camada foi realizada por examinador experiente, de forma mascarada, com os pacientes então classificados em três grupos (1, 2 e 3), em ordem crescente de integridade. Resultados: Foram incluídos no estudo 39 olhos de 37 pacientes, sendo eles 22 mulheres (59,5%) e 15 homens (40,5%). A idade média foi de 68,2 anos variando entre 51 e 83 anos. O tempo de seguimento pós-operatório médio foi de 38,5 meses. Entre todos os olhos estudados, 12 foram incluídos no grupo 1 (menor integridade); sete, no grupo 2 e vinte, no grupo 3. Na comparação entre os grupos 1 e 3, a acuidade visual final melhorou em ambos; porém, com maior intensidade no grupo 3 (p<0,001). O tamanho pré-operatório do buraco e o tempo de história da doença não impactaram significativamente o resultado visual final (p=0,223 e p=0,559, respectivamente). A acuidade visual pré-operatória média foi maior no grupo 3 que no grupo 1 (p=0,012). Conclusões: Os dados obtidos através deste estudo sugerem correlação entre uma maior integridade da camada dos fotorreceptores e um melhor resultado visual de longo prazo, em pacientes com buraco macular idiopático, operados com sucesso. Embora a visão tenha melhorado em todos os grupos, a melhora foi significativamente maior no grupo 3 que no grupo 1. Em relação ao tamanho pré-operatório da lesão e o tempo de história da doença, não se observou impacto significativo no resultado. Uma melhor acuidade visual inicial pré-operatória pode influenciar positivamente a acuidade visual final. / Purpose: To evaluate the integrity of the retina photoreceptor layer as determined by optical coherence tomography and its relationship with final visual outcome in successfully closed idiopathic macular holes. Methods: Successfully operated patients with a minimal follow-up of 12 months, underwent complete ophthalmic exam involving post-operative best corrected visual acuity using logMar scale, macula biomicroscopy and indirect ophthalmoscopy and fluorescein angiography. Complete epidemiologic data was collected as well as time duration, pre-op visual acuity, and size and Gass classification of the holes. Optical coherence tomography images of the layer corresponding to the transition between inner and outer segments of the photoreceptors were meticulously generated using commercially available Stratus OCT (OCT3). Qualitative analysis of this layer was carried out, in a masked fashion, by a certified and well experienced examiner. Based on increasing integrity showed in the images, patients were then distributed in 3 groups: 1, 2 and 3. Group 1 integrity from 1 to 33%, group 2 from 34 to 66%, and group 3 from 67 to 100%. Results: A total of 39 eyes of 37 patients were included in the study. Among all patients, 12 were included in group 1, 7 in group 3 and 20 in group 3. There were 22 female (59,5%) and 15 male (40,5%). Mean age was 68.2 years varying from 51 to 83 years of age. Mean post-op follow-up time was 38.5 months. When comparing groups 1 and 3, best corrected final visual acuity improved in both groups but dramatically in group 3 (better integrity) (p<0.001). Pre-operative size and time duration of the hole did not correlate with better visual acuity (p=0.223 and p=0.559 respectively). Mean pre-op visual acuity was better in group 3 than in group 1 (p=0.012). Conclusion: Data obtained in our study indicate that there is a strong correlation between better integrity of the photoreceptor layer, as determined by optical coherence tomography, and a more successful final, long term, visual acuity in patients with idiopathic macular hole successfully operated. Although final visual acuity has improved in all groups, there was statistical difference between groups 1 and 3. Pre-operative size and time duration of the hole did not have impact on final visual acuity. Better pre-op visual acuity may have an effect on final outcome.
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