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Progressão dos defeitos glaucomatosos em doentes com apneia obstrutiva do sono em tratamento
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Introdução: O glaucoma é uma neuropatia ótica e uma das principais causas de cegueira a nível global. Por ser uma doença silenciosa é importante conhecer os fatores de risco. Segundo a literatura, patologias como a Síndrome da Apneia Obstrutiva do Sono (SAOS) contribuem para o seu aparecimento.
Objetivos: Clarificar a associação da SAOS com o glaucoma e compreender a relação entre a terapêutica com pressão positiva na via aérea (PAP) e as alterações glaucomatosas através do estudo da progressão dos defeitos glaucomatosos, de modo a criar um encaminhamento eficaz para estes doentes.
Métodos: O presente estudo de coorte e observacional permitiu avaliar a influência da severidada da SAOS nos indicadores oftalmológicos. Numa abordagem prospetiva e longitudinal permitiu avaliar a progressão dos defeitos glaucomatosos, segundo a adesão à PAP, através da avaliação da pressão intra-ocular (PIO), acuidade visual (AV) campos visuais (CV) e tomografia de coerência óptica (OCT). Os doentes foram avaliados antes do início da terapêutica com PAP, quatro, oito e doze meses após o início da mesma.
Resultados: A amostra incluiu 88 pacientes diagnosticados com SAOS. Após o diagnóstico não se observaram alterações significativas entre os grupos de severidade da SAOS, embora se tenha observado um aumento da PIO e diminuição de camada de fibras nervosas (RNFL) e anel neuroretiniano (MRW) no grupo com SAOS grave. Após doze meses, observou-se um aumento da PIO, para todos os grupos de adesão (p <0,001), e uma melhoria do campo visual para o grupo com boa adesão.
Conclusões: A severidade da SAOS não mostrou ter impacto significativo para as variáveis associadas ao glaucoma. Após um ano de utilização de terapêutica PAP, os resultados sugerem um aumento da PIO, independentemente da adesão, mas também uma preservação funcional e estrutural da visão para o grupo de boa adesão.
Abstract Background: Glaucoma is an optic neuropathy and one of the leading causes of blindness worldwide. As a silent disease, it is essential to identify its risk factors. According to the literature, some systemic diseases, such as Obstructive Sleep Apnea (OSA) contribute to the development of glaucoma. Objectives: To clarify the association between OSA and glaucoma and to understand the connection between positive airway pressure (PAP) therapy and glaucomatous changes. Aiming to establish effective referral pathways for patients. Methods: This cohort and observational study clarify the impact of severity of OSA on ophthalmologic parameters. On a prospective and longitudinal approach the progression of glaucomatous defects was evaluated using functional and structural parameters, as well as intraocular pressure (IOP) and visual acuity (VA). Eligible data included patients who have been assessed before initiating PAP therapy and then at four, eight and twelve months after its initiation. The analysis considered PAP adherence. Results: This study includes 88 patients diagnosed with OSA. After the diagnose, it was not possible to observe any significant changes within the group of patients diagnosed with severe OSA. However, it was possible to observe an increase of IOP and a decrease the thickness of retinal nerve fiber layer (RNFL) and minimum width rim (MRW) within this group. 12 Months results suggest an increase in IOP for the eligible data (p <0,001) and an improvement in visual field Conclusion: OSA severity did not show significant changes suggesting being associated with glaucoma. After one year of PAP treatment was possible to observe an increase in IOP as well as a funcional and structural preservation of the vision for all eligible data, confirming that there is a connection between PAP therapy and glaucomatous changes.
Abstract Background: Glaucoma is an optic neuropathy and one of the leading causes of blindness worldwide. As a silent disease, it is essential to identify its risk factors. According to the literature, some systemic diseases, such as Obstructive Sleep Apnea (OSA) contribute to the development of glaucoma. Objectives: To clarify the association between OSA and glaucoma and to understand the connection between positive airway pressure (PAP) therapy and glaucomatous changes. Aiming to establish effective referral pathways for patients. Methods: This cohort and observational study clarify the impact of severity of OSA on ophthalmologic parameters. On a prospective and longitudinal approach the progression of glaucomatous defects was evaluated using functional and structural parameters, as well as intraocular pressure (IOP) and visual acuity (VA). Eligible data included patients who have been assessed before initiating PAP therapy and then at four, eight and twelve months after its initiation. The analysis considered PAP adherence. Results: This study includes 88 patients diagnosed with OSA. After the diagnose, it was not possible to observe any significant changes within the group of patients diagnosed with severe OSA. However, it was possible to observe an increase of IOP and a decrease the thickness of retinal nerve fiber layer (RNFL) and minimum width rim (MRW) within this group. 12 Months results suggest an increase in IOP for the eligible data (p <0,001) and an improvement in visual field Conclusion: OSA severity did not show significant changes suggesting being associated with glaucoma. After one year of PAP treatment was possible to observe an increase in IOP as well as a funcional and structural preservation of the vision for all eligible data, confirming that there is a connection between PAP therapy and glaucomatous changes.
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Sindrome da apneia obstrutiva do sono Glaucoma Pressão intraocular Campo visual Tomografia de coerência ótica Obstructive sleep apnea Intraocular pressure Visual field Optical coherence tomography