The purpose of this study was to investigate morphological changes in the outflow pathway from Schlemm’s canal (SC) to the intrascleral vessels (ISVs) in POAG eyes through comparisons with age-matched, normal control eyes using light microscopy and morphometric analysis. We hypothesized that there would be a reduction in the size and number of ISVs when SC becomes narrower and collapsed in the eyes with POAG and there would be no reduction in size and number of ISVs when SC is open in eyes with POAG. 11 normal eyes from 10 donors (63-92 years old) without a history of ocular diseases and 10 POAG eyes from 6 donors (67-90 years old) with clinically confirmed diagnoses of POAG were acquired. The eyes were fixed and embedded. The sections of anterior chamber angle (2-3 μm in thickness) were cut, stained with sectioning procedures, and imaged using a light microscope. 36 images from 11 normal eyes and 40 images from 10 glaucomatous eyes were examined and analyzed in this study. Cross-sectional area (CSA), width, height of SC and percentage collapse of SC as well as the number and CSA of ISVs were measured within each quadrant of the eye. Statistical analyses were conducted using one-way ANOVA and Kruskal-Wallis test in the IBM SPSS software. A significant reduction in height, width, and CSA of SC, and a significant increase in percentage of SC collapse were found in 70% of POAG eyes, while open SC was found in 30% of POAG eyes when compared to normal eyes. Decreased sizes and number of ISVs were observed in 70% of POAG eyes with narrower and collapsed SC, but these changes did not reach statistical significance. Decreased sizes of ISVs were observed in 30% of POAG eyes with open SC, although these changes did not reach statistical significance. The results suggested that smaller and collapsed SC was found in 70% of eyes with POAG. Ultimately, the decreased size and number of ISVs found in POAG eyes may be secondary to decreased size and collapse of SC in POAG pathology.

Submitted by admin tede (tede@pucgoias.edu.br) on 2016-08-18T13:40:01Z No. of bitstreams: 1 Nathalie Borges Costa.pdf: 1419823 bytes, checksum: 9601be4b45901e83f91a699e9111d75f (MD5) / Made available in DSpace on 2016-08-18T13:40:01Z (GMT). No. of bitstreams: 1 Nathalie Borges Costa.pdf: 1419823 bytes, checksum: 9601be4b45901e83f91a699e9111d75f (MD5) Previous issue date: 2011-12-07 / Glaucoma encompasses a group of eye diseases characterized by retinal ganglion cell damage, optical nerve damage and visual field loss. It is a complex optic neuropathy of genetically heterogeneity which can lead to irreversible blindness. The visual field loss is a late manifestation symptom, therefore it is not a reliable symptom to detect glaucoma in its early stages. It is the second biggest cause of blindness worldwide, responsible for 12% of all the cases of complete vision loss, while cataracts are responsible for 48% of reversible blindness worldwide. A positive family history plays an important role as a risk factor for primary openangle glaucoma development. This is the most common form of glaucoma and it typically occurs after 40 years old of age. If the disease is neither detected nor treated properly the risk of blindness is higher. Patients with a positive family history or patients with mutations in genes that are known to be associated with glaucoma should have medical attention in order to prevent later complications. In this way it is extremely important to seek new genes that could be related to glaucoma. Up to this time three genes have been associated with primary open-angle glaucoma, the myocilin gene (MYOC), the optineurin gene (OPTN) and the repeat domain 36 gene (WDR36). The CYP1A1 gene, located at 15q22-q24, encodes an enzyme which is involved in the conversion of chemical substances into highly reactive species leading to unwanted cell damage, cell death or mutation. The m1 polimorphism is related to a high rate of enzyme activity and it comprises increased lung cancer susceptibility. The objective of this paper is to analyze the correlation of 100 patients with primary open-angle glaucoma and 52 normal controls by the RFLP method (Restriction Fragment Length polymorphism). The frequency of the homozygous wild-type (w1/w1) of CYP1A1 gene among patients with primary open-angle glaucoma (n=100) was 16%, for the genotype w1/m1 the frequency of was 77% and for m1/m1 it was 7%. Among the control group (n=52) the frequency of the homozygous wild-type (w1/w1) of CYP1A1 gene was 54%, the frequency of w1/m1 was 46% and m1/m1 was 0%. The qui-square test ( 2) considered the result statistically significant (P<0,0001), and this suggests that the CYP1A1m1 polymorphism is associated with primary open-angle glaucoma. / Glaucoma engloba inúmeras doenças oculares que têm como característica a lesão das células ganglionares da retina, com conseqüente lesão do nervo óptico e perda do campo visual. É considerada uma neuropatia óptica complexa e geneticamente heterogênea, levando à cegueira irreversível. A perda do campo visual é uma manifestação tardia do glaucoma, e portanto não é particularmente adequada para a detecção da doença em seu início. É a segunda causa de cegueira no mundo, respondendo por 12% dos casos, ficando atrás apenas da catarata (48%). A história familiar positiva é um importante fator de risco para o desenvolvimento do glaucoma primário de ângulo aberto, que é a forma mais comum da doença e que se manifesta principalmente após os 40 anos. O glaucoma, quando não diagnosticado e, portanto não tratado, pode levar a um risco maior de cegueira. Sendo assim, indivíduos com histórico familiar ou mesmo alterações nos genes associados ao glaucoma devem ter uma atenção médica mais dirigida aos seus aspectos preventivos, por isso a importância da procura de novos genes associados ao glaucoma. Até o momento foram identificados três genes relacionados ao glaucoma primário de ângulo aberto, o gene myocilin (MYOC ), o optineurin (OPTN) e o gene de domínio de repetição WD 36 (WDR36). O gene CYP1A1, localizado no cromossomo 15q22-q24, codifica enzima que está envolvida na conversão de produtos químicos em moléculas altamente reativas, que podem produzir dano celular indesejado, morte celular ou mutações. O polimorfismo m1 está associado a uma maior atividade enzimática, tendo sido referido como fator genético de suscetibilidade para o câncer de pulmão. Este trabalho teve como objetivo verificar a possível associação entre 100 doentes com glaucoma primário de ângulo aberto e 52 controles por RFLP (polimorfismo de comprimento de fragmentos de restrição). A frequência do gene CYP1A1 entre os pacientes com glaucoma primário de ângulo aberto (n=100) para o genótipo homozigoto selvagem w1/w1 foi de 16%; 77% para o genótipo w1/m1 e 7% para o genótipo m1/m1. Entre os pacientes do grupo controle (n=52) a freqüência do gene CYP1A1 foi de 54% para o genótipo w1/w1, sendo a freqüência para o genótipo w1/m1 igual a 46% e 0% para o genótipo m1/m1. Foi realizado o 2 que mostrou que o resultado deste trabalho é estatisticamente significativo (P<0,0001), sugerindo relação entre o polimorfismo CYP1A1m1 e o glaucoma primário de ângulo aberto.

In the Kuehn lab, it has been shown that inducible pluripotent stems cells that have been induced to be trabecular meshwork cell-like (iPSC-TM) have a unique ability to regenerate dysfunctional trabecular meshwork (TM) cells by sharing specific unknown factors. In this thesis will discuss the novel means by which I isolate primary human Trabecular Meshwork (pTMs) and efficiently prepare cell cultures for experimentation, such as a sequencing experiment in which I studied expression changes that arose when the TM cell culture’s cell cycle control is manipulated. Previous research has shown that pTM grow atypical when 100% confluent compared to other epithelial cells creating an interesting time frame by which to observe their unique cell cycle control. Using newly isolated TM cell cultures I investigated expression of mRNA and miRNA to understand their roles in cell cycle control of these atypical cultures. With regards to the isolation of TM cell cultures were able to show that the “Crawling Out” methodology is an effective way to establish a pure TM cell line with both a low contamination rate and less passages/time. With these cultures we were able to establish 50 mRNAs and 19 miRNAs that were differential expressed in the TM cell cultures that were atypically grown. When reviewing the literature many of these expression changes were linked to carcinogenics, and the progression/prognosis of various cancer types.

Background: The aim of this retrospective study was to compare the efficacy and safety profile of a single XEN-microstent in different types of primary and secondary open angle glaucoma. Methods: A single XEN microstent was implanted in patients with primary open-angle glaucoma (POAG), normal-tension glaucoma (NTG), pseudoexfoliation glaucoma (PEX) and secondary glaucoma (Sec.Gl). The intraocular pressure (IOP), the active substances of the applied IOP-lowering drugs, the best corrected visual acuity (BCVA) and the mean deviation (MD) of the perimetry were measured at baseline and at regular follow-ups, scheduled at 2 days and 1, 3, 6 and 12 months after surgery. Results: 153 eyes were included in this analysis. 113 eyes were affected by POAG (74%), 5 eyes by NTG (3%), 22 eyes by PEX (14%) and 13 eyes by Sec. Gl (9%). Mean IOP decreased in all treatment groups during the 12 months of follow-up (complete group: 23.9 ± 7.4 to 15.4 ± 5.1 mmHg (p < 0.01); POAG: 22.8 ± 6.5 to 15.1 ± 4.6 mmHg (p < 0.01); NTG: 16.6 ± 3.4 to 11.6 ± 2.2 mmHg (p < 0.05); PEX: 28.0 ± 7.9 to 17.1 ± 6.6 mmHg (p < 0.01); Sec.Gl: 28.9 ± 13.9 to 15.5 ± 6.9 mmHg (p < 0.05)). In the 153 eyes the average number of IOP-lowering drugs applied decreased from 2.6 ± 1.2 to 0.8 ± 1.3 12 months after surgery (p < 0.01). BCVA and mean deviation of automated standard perimetry remained stable in all groups during follow-up. Conclusion: As in eyes suffering from POAG, IOP and number of IOP-lowering drugs applied can be effectively reduced by XEN implantation in eyes suffering from NTG, PEX and secondary glaucoma while leaving BCVA and visual field unchanged.

Primary open-angle glaucoma (POAG) is one of the leading causes of blindness worldwide. The only modifiable risk factor for POAG is elevated intraocular pressure, resulting from increased aqueous humor production or decreased drainage. Resistance to drainage in the aqueous outflow pathway is believed to reside in the juxtacanalicular connective tissue (JCT) and to be modulated by the inner wall (IW) endothelium of Schlemm’s canal (SC); however, the mechanisms that increase resistance in POAG remain unclear. To cross the IW, aqueous humor passes through I-pores on giant vacuoles (GVs) or B-pores between adjacent endothelial cells. Additionally, outflow around the circumference of the eye is segmental, or non-uniform, and fluorescent tracers can be used to label areas of high-flow and non-flow. The morphological differences in the endothelial cells of SC and their GVs in high- vs. non-flow areas have not been fully elucidated. In this project, we investigated the role of GVs and pores in the IW endothelial cells of SC in regulating segmental outflow in human eyes. We used serial block-face scanning electron microscopy to generate thousands of serial images and visualize these structures in 3D at the ultrastructural level. First, we 3D-reconstructed 45 individual IW cells and their GVs and quantified the number of connections each cell makes with the underlying JCT matrix/cells. We found that cells in high-flow areas made significantly fewer connections to JCT matrix/cells compared to cells in non-flow areas. Secondly, we analyzed 3,302 GVs for I-pores and basal openings and found a significantly greater percentage of GVs with both basal openings and I-pores in high-flow area compared to non-flow area, suggesting this type of GVs form a channel through which aqueous humor passes from JCT to SC. We also found that GVs with I-pores were significantly larger than those without I-pores. Our results suggest that decreasing number of cellular connections and increasing number of GVs with pores may be potential strategies to increase the amount of high-flow area and aqueous outflow for glaucoma treatment. Together, these studies add to our understanding of the role of GVs and pores in regulating segmental flow around the eye.

The aim of this study was to compare the efficacy of trabeculectomy (TE), single XEN microstent implantation (solo XEN) or combined XEN implantation and cataract surgery (combined XEN) in primary open-angle glaucoma cases, naïve to prior surgical treatment, using a monocentric retrospective comparative cohort study. Intraocular pressure (IOP) and the number of IOP-lowering drugs (Meds) were monitored during the first 24 months after surgery. Further disease progression was monitored using peripapillary retinal nerve fiber layer (RNFL) thickness examinations using spectral domain optical coherence tomography (OCT) as well as visual acuity (VA) and visual field (VF) tests. In the TE group (52 eyes), the mean IOP decreased from 24.9 ± 5.9 to 13.9 ± 4.2 mmHg (p < 0.001) and Meds decreased from 3.2 ± 1.2 to 0.5 ± 1.1 (p < 0.001). In the solo XEN (38 eyes) and the combined XEN groups, the mean IOP decreased from 24.1 ± 4.7 to 15.7 ± 3.0 mmHg (p < 0.001) and 25.4 ± 5.6 to 14.7 ± 3.2 mmHg (p < 0.001), while Meds decreased from 3.3 ± 0.8 to 0.8 ± 1.2 (p < 0.001) and 2.7 ± 1.2 to 0.4 ± 1.0 (p < 0.001), respectively. The VF and VA indices showed no sign of further deterioration, the RNFL thickness further decreased in all treatment groups after surgery. TE and XEN led to comparable reductions in IOP and Meds. Although the VA and VF indices remained unaltered, the RNFL thickness continuously decreased in all treatment groups during the 24-month follow-up.

A busca visual é uma habilidade crítica para várias tarefas da vida diária e pode estar prejudicada em pacientes com deficiência visual. O objetivo deste estudo foi comparar a busca visual exploratória entre pacientes com glaucoma primário de ângulo aberto (GPAA) e controles saudáveis, avaliando a correlação espacial entre áreas com perdas localizadas na busca visual exploratória e os defeitos perimétricos, em pacientes com GPAA e com visão normal. Cinquenta e sete indivíduos com visão normal (acuidade visual corrigida melhor que 0.2 logMAR) diagnosticados (grupo GPAA, n = 29) ou não (grupo CONTROL, n = 28) com GPAA, realizaram um exame oftalmológico completo, incluindo perimetria visual (Humphrey -Fast 24.2) e uma tarefa exploratória de busca visual baseada em uma tela com dígitos. Um software personalizado quantificou o (s) tempo (s) gasto (s) até o encontro do número \"4\" em uma matriz aleatória de dígitos distribuídos em cinco áreas, em nove telas sequenciais do programa. Cinco áreas da tela de busca visual foram espacialmente correlacionadas com cinco setores do mapa total deviation (TD) da perimetria visual, após ajustes de ângulo e distância. A análise de covariância (ANCOVA) e testes de correlação foram utilizados para correlacionar parâmetros perimétricos e da busca visual exploratória, por meio de avaliação do tempo individual (gasto para encontrar cada dígito) e tempo total (gasto para completar a tarefa). Os pacientes com GPAA apresentaram pior sensibilidade perimétrica (MD) e de busca visual exploratória do que os controles (MD: -8,02 ± 7,88 dB vs -1,43 ± 1,50 dB; p <0,0001 e tempo total: 106,42 ± 59,64 s vs 52,75 ± 19,07 s; p < 0.0001). A sensibilidade do MD de ambos os grupos correlacionou-se significativamente com o tempo total (GPAA: r = -0.45; p = 0,01 e CONTROL: r = 0,37; p = 0,049). Os testes de ANCOVA mostraram uma correlação significativa entre a busca visual exploratória (tempo individual) e a acuidade visual (P = 0,006) e o diagnóstico de glaucoma (p = 0,005). A sensibilidade média das áreas perimétricas periféricas do grupo GPAA mostrou correlação significativa com o tempo de busca individual nas áreas espaciais correspondentes, exceto na área periférica temporal superior (r = -0,35, p = 0,06). Os controles não mostraram correlação significativa para nenhuma dessas áreas perimétricas, exceto a área periférica temporal superior (r = 0,43, p = 0,02). Com base em nossos resultados, regiões com pior desempenho na busca visual exploratória puderam ser correlacionadas às perdas periféricas localizadas dos pacientes com GPAA. Uma vez que foram estudados pacientes com acuidade visual normal, estes achados destacam a importância do uso de ferramentas de busca visual na avaliação do impacto das perdas perimétricas periféricas em atividades diárias de pacientes com glaucoma. / Visual search is a critical skill for several daily tasks and may be declined in patients with impaired vision. The objectives of this study were to compare the exploratory visual search performance (EVSP) between patients with primary open-angle glaucoma (POAG) and healthy controls, and evaluate the spatial correlation between localized decreases in the EVSP and areas of visual field (VF) loss in normally-sighted patients POAG. Fifty-seven normal vision subjects (best corrected visual acuity better than 0.2 logMAR) diagnosed (POAG group; n= 29) or not (CONTROL group; n= 28) with POAG yielded a complete comprehensive ophthalmological examination, including Humphrey VF tests (SITA-Fast 24.2), and an exploratory visual search digit-based task. A custom software quantified the time (s) spent until patients found the number \"4\" on a random array of digits distributed in five areas on nine sequential screens. Each area was spatially matched with five sectors of the total deviation map from VF, after angle and distance adjustments. Covariance (ANCOVA) and correlation tests were used for correlating VF parameters and EVSP, evaluated through individual time (spent for finding each digit) and total time (spent for completing the task). POAG patients presented worse VF mean deviation (MD) sensitivity and EVSP than controls (MD: -8.02±7.88 dB vs -1.43±1.50 dB; p<0.0001, and total time: 106.42±59.64 s vs 52.75±19.07 s; p<0.0001). MD sensitivity of both groups significantly correlated with total time (POAG: r = -0.45; p = 0.01 and CONTROL: r = 0.37; p = 0.049). ANCOVA tests showed a significant correlation between EVSP (individual time) and both visual acuity (p = 0.006) and glaucoma diagnosis (p = 0.005). The mean sensitivity of the peripheral VF areas of the POAG group showed significant correlation with the individual search time in the corresponding spatial areas, except in the peripheral temporal superior area (r = -0.35, p =0.06). Controls did not show a significant correlation for any of those VF areas, except the peripheral temporal superior area (r =0.43, p =0.02). Based on our results, worse EVSP can be attributable to localized losses in the peripheral VF areas in patients with POAG. Since only normally sighted patients were studied, these findings highlight the importance of using visual search tools to evaluate the impact of peripheral VF loss in daily activities of glaucoma patients, such as driving.

Made available in DSpace on 2016-08-10T10:38:44Z (GMT). No. of bitstreams: 1 Leonardo Mariano Reis.pdf: 8263558 bytes, checksum: d4842ddc6615e7587ee43da1794b8d63 (MD5) Previous issue date: 2013-03-18 / Abstract of the First Chapter Objective: The objective was to make a wide review of the literature about the genetic aspects of glaucoma, with a highlight at the works dealing with mitochondrial DNA. Methods: Bibliographical research was carried out accessing the sites Scopus, Science Direct, PubMed, Scirus, Scielo and Google. Books, theses and dissertations were also used at the research. Results: The works brought to evidence that there is a relation between certain polymorphisms in mitochondrial DNA and a higher loss of retinal ganglion cells, which leads to the development of Glaucoma, especially Primary Open Angle Glaucoma. Conclusion: Higher incidence of Primary Open Angle Glaucoma (POAG) in afro-descendants is justified by the mitochondrial haplotypes, since it was observed a higher susceptibility of POAG in individuals of the L haplogroups, who are exactly the ones of African origin. It could also justify, based on mitochondrial inheritance, the major incidence of POAG in the maternal lineages, more frequent than paternal inheritance. Abstract of the Second Chapter Objective: To quantify the volume of the scientific production about Primary Open Angle Glaucoma and Mitocohndrial DNA and assess which are the main institutions of research; verify the contribution of the authors that most published about the subject; list the main journals with their Impact Factor; compare the countries and other bibliometric results. Methods: Bibliographical research about mitochondrial DNA and Primary Open Angle Glaucoma was carried out accessing the site Scopus. Then, search with the keywords mitochondrial DNA and glaucoma in all fields for publications until august of 2012 was performed. Finally, data was tabulated and the descriptive statistics was done, with the principal data, as: authors that published about mitochondrial DNA and Primary Open Angle Glaucoma; journals that had works about the subject; Research Centers and Universities that most published; countries where the researchs were performed. Results: The works brought to evidence the influences of certain polymorphisms in mitochondrial DNA at the development of Primary Open Angle Glaucoma. Statistics showed that theese articles have increased in the last few years, though yet confined, mostly, to some centers of research and concentrated in selected researchers in ophthalmology of developed countries. In Brazil, we do not have any article published about the issue, yet. Conclusion: 98 works were listed, until august of 2012, carried out in 30 countries, with higher concentration in the United States and England, but also with contributions of the Arabic world: Qatar and Saudi Arabia. There were more publications in the following journals: Molecular Vision, Investigative Ophthalmology and Visual Science, Archives of Ophthalmology, British Journal of Ophthalmology, Experimental Eye Research, Journal of Glaucoma and Progress in Retinal and Eye Research. More studies about the subject must be encouraged, for they are extremely important to the elucidation of the genetic causes of glaucoma and for the development of new therapies aiming not only the reduction of intraocular pressure. / RESUMO DO CAPÍTULO I Objetivo: O objetivo foi fazer uma ampla revisão de toda a literatura sobre os aspectos genéticos do glaucoma, com enfoque nos trabalhos que envolvem pesquisa com DNA mitocondrial. Métodos: A pesquisa bibliográfica foi realizada por meio das bases de dados: Scopus, Science Direct, PubMed, Scirus, Scielo e pelo sítio de busca Google. Foi feito também levantamento através de livros, dissertações e teses. Resultados: Os trabalhos evidenciaram que há alguma correlação de determinadas linhagens de DNA mitocondrial com maior perda de células ganglionares da retina, o que acaba levando ao desenvolvimento do glaucoma propriamente dito, sobretudo do glaucoma primário de ângulo aberto. Conclusão: Explica-se a maior incidência de glaucoma primário de ângulo aberto em indivíduos afrodescendentes a partir de haplótipos mitocondriais, uma vez que houve maior susceptibilidade ao glaucoma primário de ângulo aberto em haplótipos pertencentes aos grupos L, que são justamente os de origem africana. Também poder-se-ia justificar, a partir da herança mitocondrial, a maior incidência de glaucoma primário de ângulo aberto quando a linhagem materna apresenta a doença, bem mais frequente do que a herança paterna. RESUMO DO CAPÍTULO II Objetivo: Quantificar o volume da produção científica que relaciona o DNA mitocondrial com o Glaucoma Primário de Ângulo Aberto e avaliar quais são as principais instituições; verificar a contribuição dos autores que mais produziram publicações sobre o assunto; listar os principais veículos com os respectivos Fatores de Impacto; comparar os países que mais fizeram trabalhos sobre o tema e outros resultados bibliométricos. Métodos: A pesquisa bibliográfica de trabalhos envolvendo DNA mitocondrial e Glaucoma Primário de Ângulo Aberto foi realizada por meio da base de dados do sítio Scopus. Foi feito o levantamento a partir das palavras-chaves Mitochondrial DNA e Glaucoma em todos os campos para publicações até agosto de 2012. Finalmente, realizada a tabulação dos dados obtidos e a estatística descritiva, com o principais dados como: autores que publicaram sobre o assunto DNA mitocondrial e glaucoma; revistas e outras publicações que tiveram trabalhos relacionados com o tema; Centros de Pesquisa e Universidades que mais publicaram e países onde foram realizados os estudos sobre DNA mitocondrial e glaucoma. Resultados: Os trabalhos evidenciaram a influência de determinados polimorfismos de DNA mitocondrial no desenvolvimento do Glaucoma Primário de Ângulo Aberto. A estatística mostrou que esses estudos têm aumentado sobremaneira ao longo dos últimos anos, mas ainda se encontram confinados, na maior parte, a alguns centros de pesquisa e concentrados em seletos grupos de autores na área da oftalmologia em países desenvolvidos. No Brasil, ainda não temos pesquisas publicadas sobre o assunto até o momento. Conclusão: Foram listados 98 trabalhos até agosto de 2012, realizados em 30 países, com maior concentração nos Estados Unidos e Inglaterra; mas também com contribuições do mundo árabe: Arábia Saudita e Catar. Esses estudos foram mais publicados nas revistas: Molecular Vision, Investigative Ophthalmology and Visual Science, Archives of Ophthalmology, British Journal of Ophthalmology, Experimental Eye Research, Journal of Glaucoma e Progress in Retinal and Eye Research. Mais estudos sobre o assunto devem ser encorajados pois são de fundamental importância para a elucidação das causas genéticas do glaucoma e para o desenvolvimento de novas terapias que não visem tão somente a diminuição da pressão intraocular.

A busca visual é uma habilidade crítica para várias tarefas da vida diária e pode estar prejudicada em pacientes com deficiência visual. O objetivo deste estudo foi comparar a busca visual exploratória entre pacientes com glaucoma primário de ângulo aberto (GPAA) e controles saudáveis, avaliando a correlação espacial entre áreas com perdas localizadas na busca visual exploratória e os defeitos perimétricos, em pacientes com GPAA e com visão normal. Cinquenta e sete indivíduos com visão normal (acuidade visual corrigida melhor que 0.2 logMAR) diagnosticados (grupo GPAA, n = 29) ou não (grupo CONTROL, n = 28) com GPAA, realizaram um exame oftalmológico completo, incluindo perimetria visual (Humphrey -Fast 24.2) e uma tarefa exploratória de busca visual baseada em uma tela com dígitos. Um software personalizado quantificou o (s) tempo (s) gasto (s) até o encontro do número \"4\" em uma matriz aleatória de dígitos distribuídos em cinco áreas, em nove telas sequenciais do programa. Cinco áreas da tela de busca visual foram espacialmente correlacionadas com cinco setores do mapa total deviation (TD) da perimetria visual, após ajustes de ângulo e distância. A análise de covariância (ANCOVA) e testes de correlação foram utilizados para correlacionar parâmetros perimétricos e da busca visual exploratória, por meio de avaliação do tempo individual (gasto para encontrar cada dígito) e tempo total (gasto para completar a tarefa). Os pacientes com GPAA apresentaram pior sensibilidade perimétrica (MD) e de busca visual exploratória do que os controles (MD: -8,02 ± 7,88 dB vs -1,43 ± 1,50 dB; p <0,0001 e tempo total: 106,42 ± 59,64 s vs 52,75 ± 19,07 s; p < 0.0001). A sensibilidade do MD de ambos os grupos correlacionou-se significativamente com o tempo total (GPAA: r = -0.45; p = 0,01 e CONTROL: r = 0,37; p = 0,049). Os testes de ANCOVA mostraram uma correlação significativa entre a busca visual exploratória (tempo individual) e a acuidade visual (P = 0,006) e o diagnóstico de glaucoma (p = 0,005). A sensibilidade média das áreas perimétricas periféricas do grupo GPAA mostrou correlação significativa com o tempo de busca individual nas áreas espaciais correspondentes, exceto na área periférica temporal superior (r = -0,35, p = 0,06). Os controles não mostraram correlação significativa para nenhuma dessas áreas perimétricas, exceto a área periférica temporal superior (r = 0,43, p = 0,02). Com base em nossos resultados, regiões com pior desempenho na busca visual exploratória puderam ser correlacionadas às perdas periféricas localizadas dos pacientes com GPAA. Uma vez que foram estudados pacientes com acuidade visual normal, estes achados destacam a importância do uso de ferramentas de busca visual na avaliação do impacto das perdas perimétricas periféricas em atividades diárias de pacientes com glaucoma. / Visual search is a critical skill for several daily tasks and may be declined in patients with impaired vision. The objectives of this study were to compare the exploratory visual search performance (EVSP) between patients with primary open-angle glaucoma (POAG) and healthy controls, and evaluate the spatial correlation between localized decreases in the EVSP and areas of visual field (VF) loss in normally-sighted patients POAG. Fifty-seven normal vision subjects (best corrected visual acuity better than 0.2 logMAR) diagnosed (POAG group; n= 29) or not (CONTROL group; n= 28) with POAG yielded a complete comprehensive ophthalmological examination, including Humphrey VF tests (SITA-Fast 24.2), and an exploratory visual search digit-based task. A custom software quantified the time (s) spent until patients found the number \"4\" on a random array of digits distributed in five areas on nine sequential screens. Each area was spatially matched with five sectors of the total deviation map from VF, after angle and distance adjustments. Covariance (ANCOVA) and correlation tests were used for correlating VF parameters and EVSP, evaluated through individual time (spent for finding each digit) and total time (spent for completing the task). POAG patients presented worse VF mean deviation (MD) sensitivity and EVSP than controls (MD: -8.02±7.88 dB vs -1.43±1.50 dB; p<0.0001, and total time: 106.42±59.64 s vs 52.75±19.07 s; p<0.0001). MD sensitivity of both groups significantly correlated with total time (POAG: r = -0.45; p = 0.01 and CONTROL: r = 0.37; p = 0.049). ANCOVA tests showed a significant correlation between EVSP (individual time) and both visual acuity (p = 0.006) and glaucoma diagnosis (p = 0.005). The mean sensitivity of the peripheral VF areas of the POAG group showed significant correlation with the individual search time in the corresponding spatial areas, except in the peripheral temporal superior area (r = -0.35, p =0.06). Controls did not show a significant correlation for any of those VF areas, except the peripheral temporal superior area (r =0.43, p =0.02). Based on our results, worse EVSP can be attributable to localized losses in the peripheral VF areas in patients with POAG. Since only normally sighted patients were studied, these findings highlight the importance of using visual search tools to evaluate the impact of peripheral VF loss in daily activities of glaucoma patients, such as driving.

Le glaucome représente la première cause de cécité irréversible à l’échelle mondiale. C’est une maladie neuro-dégénérative caractérisée traditionnellement par une pression intraoculaire (PIO) élevée, un dommage du nerf optique et un défaut du champ visuel correspondant. En fait, la PIO élevée constitue le facteur de risque central associé au développement du glaucome. Cependant, en dépit d’un contrôle adéquat de la PIO, la maladie continue à progresser chez certains patients. Cela montre qu’il existe d’autres facteurs impliqués dans la pathogenèse du glaucome. Des études récentes indiquent qu’un dérèglement de l’oxygène est associé à son développement. En utilisant une nouvelle technologie multi-spectrale capable de mesurer la saturation en oxygène (SaO2) dans les structures capillaires de la rétine, cette étude tentera de déterminer si un état d’oxygénation anormal pourrait se retrouver à la papille optique des patients souffrant de glaucome. Une meilleure compréhension du rôle de l’oxygène pourrait aider à améliorer le pronostic du glaucome. Les résultats de l’étude indiquent que le facteur de position (supérieure, temporale et inférieure de la papille optique) n’a aucun effet sur la mesure SaO2 ainsi que sa variabilité chez les patients normaux. La comparaison de la SaO2 entre les sujets normaux et glaucomateux ne montre pas de différence statistiquement significative. En conclusion, la SaO2 «normale» mesurée dans les yeux glaucomateux n'exclut pas nécessairement que l'hypoxie ne soit pas impliquée dans la pathogenèse. Au moment de l’étude, la PIO était bien contrôlée par des médicaments topiques, ce qui pourrait influencer l’oxygénation à la papille optique. / Glaucoma is the leading cause of irreversible blindness worldwide. Traditionally, open-angle glaucoma was defined as a neurodegenerative disease characterized by high intraocular pressure (IOP), progressive retinal cell death with subsequent visual field loss. Elevated IOP has been identified as one of the major risk factors for glaucomatous optic nerve damage. However, adequate IOP control cannot prevent progression of the disease in all patients suggesting that there are other factors involved in the pathogenesis of glaucoma. Recent studies suggest that hypoxia may contribute to the development of glaucoma. Using a new multi-spectral detection system of oxygen saturation (O2Sa), this study determined whether an abnormal state of oxygenation at the optic disc could be found in glaucoma patients. Knowledge about the influence of the oxygen in glaucoma may help to improve the pronostic of the disease. The results of the study indicate that the position factor (superior, temporal and inferior of the optic nerve head) has no effect on the measurement of O2Sa and its variability in normal patients. Comparing the O2Sa between normal subjects and glaucoma subjects shows no statistically significant difference. In conclusion, the «normal» O2Sa measured in glaucomatous eyes does not necessarily exclude that hypoxia is not involved in the pathogenesis of glaucoma because glaucoma patients were under treatment with topical drops that lowered IOP. These medicines could affect the oxygenation of the optic disc.