Cláudia Gomide Vilela de Sousa Franco’s research while affiliated with Federal University of Goiás and other places

Background: This study compares the preparation time and the macroscopic integrity of Descemet membrane and endothelium keratoplasty (DMEK) grafts prepared using the modified submerged cornea using backgrounds away (SCUBA) technique compared to those prepared with a newly developed artificial chamber device specifically designed for DMEK preparation. Research design and methods: This is a prospective, comparative, randomized, and experimental study. Fifty corneas from 25 donors were used. The inclusion criteria were that both eyes were of the same donor, a scleral ring greater than 3 mm, and corneas unsuitable for clinical use. Preparation time and macroscopic tissue integrity were evaluated at the end of preparation. Results: The mean preparation time for both techniques was six minutes (p=0.2). The macroscopic integrity of the graft was similar between the inverted artificial chamber device and the modified SCUBA technique (p=1.00). Conclusions: The upside-down artificial chamber operating with the upside-down cornea proved reproducible and macroscopically suitable for endothelial graft preparation for the DMEK technique.

This retrospective, comparative, multicenter study aimed to evaluate the real-world outcomes and predictors of failure of Gonioscopy-assisted transluminal trabeculotomy (GATT) at 12 months in glaucoma patients. Predictors of failure of absolute success in bilateral cases (422 eyes of 308 patients) included pre-operative intraocular pressure (IOP; IRR = 1.02; p = 0.01), and pre-operative mean deviation (MD; IRR = 0.98; p = 0.007). The significant predictors of failure of relative success included binocularity (IRR = 4.05; p = 0.001) and pre-operative IOP (IRR = 1.04; p = 0.022). Only one eye per patient (308 eyes) was included in the second analysis. IOP reduced from 21.84 ± 7.96 mmHg to 11.97 ± 2.89 mmHg at 12 months; the number of hypotensive eye drop medications decreased from 3.07 ± 1.04 to 1.06 ± 1.08 (p <0.001 for both). The pre-operative IOP was a predictive factor for failure of absolute (IRR = 1.02; p = 0.026) and relative successes (IRR = 1.05; p = 0.014). The number of hypotensive medications only affected absolute success (IRR = 1.25; p = 0.004). The Kaplan–Meier graph revealed relative and absolute success in 88.9% and 43.9% of cases, respectively. No serious complications were observed in the study.

Purpose The aim of this study is to compare the diagnostic performance in differentiating patients with glaucoma from those with presumed large physiological optic disc cupping (LPC), using optic nerve head hemoglobin levels (ONH Hb), as a screening method, versus the evaluation of general ophthalmologists. Patients and Methods Twenty general ophthalmologists evaluated PowerPoint images of 40 patients with glaucoma and 40 presenting LPC. Presentation of patient’s exams were distributed as follows: Group 1 (GI): color retinography (CR), Group 2 (GII): CR + visual field (VF), Group 3 (GIII): CR + optical coherence tomography (OCT), Group 4 (GIV): CR + VF + OCT. The Laguna ONhE software was used to estimate ONH Hb based on CR. Main outcomes were the comparison of sensitivity and accuracy between general ophthalmologists’ evaluation and the glaucoma discriminant function (GDF) index from Laguna ONhE and also the agreement between examiners (Kappa statistics). Results Laguna ONhE GDF index demonstrated higher sensitivity values (GI- 90%; GII-90%; GIII-100%; GIV-100%) comparing to all groups (GI-59%; GII-86.5%; GIII-86.5%; GIV-68.5%). In GI, in which it was observed the worst accuracy result (64.8%), we found 75% for GDF. In GII, the accuracy was 81.3% and we found 55% for GDF. The highest agreement was in GII (Kappa=0.63; 95% CI=0.53–0.72), and the lowest in GI (Kappa=0.30; 95% CI=0.20–0.39). Conclusion Laguna ONhE software, a low-cost and non-invasive method, showed good sensitivity and great utility as a screening method in differentiating patients with glaucoma from those with LPC, compared with evaluation of general ophthalmologists.

Purpose: To compare the use of visual field and/or optical coherence tomography (OCT) combined with color retinography by non-glaucoma specialists for differentiating glaucoma from physiological cupping. Methods: Eighty patients with glaucoma or physiological cupping (40 of each) were randomized according to the examination used (GI: color retinography, GII: color retinography + visual field, GIII: color retinography + optical coherence tomography, GIV: color retinography + visual field + optical coherence tomography). Twenty non-specialist ophthalmologists diagnosed glaucoma from PowerPoint slide images, without direct patient examination. Results: Inter-examiner agreement was good for GII (ĸ: 0.63; 95%CI, 0.53-0.72), moderate for GIII (ĸ: 0.58; 95%CI, 0.48-0.68) and GIV (ĸ: 0.41; 95%CI, 0.31-0.51), and low for GI (ĸ: 0.30; 95%CI, 0.20-0.39) (p<0.001). Diagnostic accuracy was higher in GIII (15.8 ± 1.82) than GI (12.95 ± 1.46, p<0.001) and higher in GII (16.25 ± 2.02) than GI and GIV (14.10 ± 2.24) (both p<0.001). For glaucoma patients only, diagnostic accuracy in GII and GIII was superior to that in GI and GIV (both p<0.001). Sensitivity and specificity were 59% and 70.5% in GI; 86.5% and 76% in GII, 86.5% and 71.5% in GIII; and 68.5% and 72.5% in GIV, respectively. Accuracy was highest in GII (81.3% [95%CI, 77.1-84.8]), followed by GIII (79% [95%CI, 74.7-82.7]), GIV (70,5% [95%CI, 65.9-74.8]), and GI (64.8% [95%CI, 60.0-69.3]). Conclusions: Non-glaucoma specialists could not differentiate glaucoma from increased physiological cupping when using color retinography assessment alone. Diagnostic accuracy and inter-rater agreement improved significantly with the addition of visual field or optical coherence tomography. However, the use of both modalities did not improve sensitivity/specificity.

Objective: The main purpose of this article is to compare the predictability of biometric results and final refractive outcomes expected in patients undergoing cataract surgery through phacoemulsification with and without associated trabeculectomy. Methods: Cataract patients who have undergone phacoemulsification surgery alone (control group) or associated with trabeculectomy (study group) screened. All surgeries were performed following standard protocol. For enrollment, biometrics calculated by IOL Master (Carl Zeiss Meditec, Inc.) biometry, refraction and intraocular pressure (IOP) before and after surgery were required. Data was compared between groups in addition to the correlation between variation of IOP and final refraction. Results: Thirty eyes per group were enrolled. Only prior IOP (p <0.001), IOP post-surgery (p = 0.01) and the difference in IOP (p <0.001) were statistically significant. Axial length, IOL diopter used, expected spherical refraction by biometrics and astigmatism pre- and post-surgery were similar in both groups (p=0.1; 0.4; 0.4; 0.5 and 0.3, respectively). Spherical predictability by biometrics within 0.25 diopters was noted in both the control group (range 0.06 ± 0.45) and study group (range 0.25 ± 0.97, p = 0.3). There was no statistical significance between groups for the difference between final cylinder and corneal astigmatism (p = 0.9), and the difference between axis of refractive and corneal astigmatism (p = 0.7). Conclusion: The biometric predictability in phacoemulsification surgery and the expected final refraction are significant, andare not modified by trabeculectomy in the combined surgeries.

Objective: To determine the influence of visual field results in the diagnosis of glaucoma. Methods: A questionnaire with ophthalmologists was conducted where slides of a digital photograph of the optic disc and computerized visual field exam were presented.(Physicians were instructed to answer whether glaucoma was observed in each of the slides). No other information was given to those examiners. Half of the patients had glaucoma with corresponding visual field, and the other half had physiological cupping and normal visual field. The slides were equally divided between retinography and corresponding visual field (same patient) and exams randomly exchanged, where an optic disc of glaucoma with a normal visual field was placed, and vice-versa. The order in which the slides were presented was also randomized. Results: Forty slides were evaluated by 29 ophthalmologists. No glaucoma specialist was included. The overall agreement among the examiners (Kappa) was 0.270 ± 0.281, and 0.261 ± 0.238 for the exams of the same eye and was 0.274 ± 0.217 from the slides with the exams changed (p=0.4). The diagnosis was made correctly in glaucoma patients with corresponding visual field exam in 66.89% of the cases, and in 66.20% of patients with physiological cupping. When the exams were exchanged, the results dropped to 34.13% and 35.86%, respectively (p<0.001 for both). Conclusion: Visual field results may influence the diagnosis of glaucoma by non-glaucoma specialists.