RESUMO
BACKGROUND: Diabetic retinopathy is a significant cause of vision impairment, especially affecting those of working age. There are two large, randomised controlled trials examining the effect of fenofibrate on diabetic retinopathy. OBJECTIVE: We summarise their findings, and report on the available safety data. DISCUSSION: The FIELD study reported that patients treated with fenofibrate had a statistically significant relative risk reduction in the need for laser treatment for maculopathy and proliferative retinopathy. The ACCORD-Eye study reported a statistically significant reduction in diabetic retinopathy progression in patients treated with fenofibrate and statin combination therapy compared to statin therapy alone. There is firm evidence that fenofibrate slows the progression of diabetic retinopathy and the need for more invasive treatment modalities in patients with type 2 diabetes, especially those with pre-existing retinopathy. In October 2013, Australia became the first country in the world to approve the use of this medication for this specific indication.
Assuntos
Diabetes Mellitus Tipo 2/complicações , Retinopatia Diabética/tratamento farmacológico , Fenofibrato/uso terapêutico , PPAR alfa/agonistas , Austrália , Progressão da Doença , Fenofibrato/efeitos adversos , Humanos , PPAR alfa/efeitos adversosAssuntos
Blefaroptose/etiologia , Conjuntivite/diagnóstico , Aneurisma Intracraniano/complicações , Aneurisma Intracraniano/diagnóstico por imagem , Doenças do Nervo Oculomotor/diagnóstico , Doenças do Nervo Oculomotor/etiologia , Diagnóstico Diferencial , Humanos , Imageamento Tridimensional , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios XRESUMO
CASE STUDY: Henry, 60 years of age, was referred by his general practitioner with a 3 month history of blurred vision in the left eye on a background of decreasing vision in both eyes over the preceding 6 months. He had not had his eyes examined for many years. His past medical history included hypertension,hypercholesterolaemia, type 2 diabetes mellitus, chronic renal impairment and peripheral vascular disease. Henry admitted to noncompliance with his medications and medical appointments.
Assuntos
Diabetes Mellitus Tipo 2/complicações , Retinopatia Diabética/diagnóstico , Edema Macular/etiologia , Transtornos da Visão/etiologia , Retinopatia Diabética/classificação , Retinopatia Diabética/terapia , Humanos , Edema Macular/classificação , Edema Macular/diagnóstico , Masculino , Pessoa de Meia-Idade , Midriáticos , Índice de Gravidade de Doença , Visão OcularAssuntos
Extração de Catarata , Subluxação do Cristalino/diagnóstico , Transtornos da Visão/etiologia , Adulto , Catarata/complicações , Catarata/etnologia , Catarata/reabilitação , Humanos , Subluxação do Cristalino/etiologia , Cristalino/lesões , Masculino , Havaiano Nativo ou Outro Ilhéu do Pacífico , Northern Territory , Descolamento Retiniano/complicações , Descolamento Retiniano/etiologia , Serviços de Saúde Rural , Transtornos da Visão/cirurgiaAssuntos
Córnea/patologia , Infecções Oculares Bacterianas/induzido quimicamente , Glucocorticoides/efeitos adversos , Ceratite/induzido quimicamente , Idoso , Idoso de 80 Anos ou mais , Córnea/efeitos dos fármacos , Córnea/microbiologia , Diagnóstico Diferencial , Infecções Oculares Bacterianas/diagnóstico , Infecções Oculares Bacterianas/microbiologia , Feminino , Glucocorticoides/administração & dosagem , Humanos , Ceratite/diagnóstico , Ceratite/microbiologia , Soluções OftálmicasRESUMO
A man, 75 years of age, presents with a red, painful, watery right eye of 1 week duration. He describes photophobia but says his vision is not reduced or blurry. He was seen at another clinic after 2 days of symptoms and was prescribed topical chloramphenicol antibiotic eye drops. Despite using the eye drops for 5 days, there has been no improvement in his symptoms. The man has no significant ocular past history.
Assuntos
Conjuntivite/virologia , Ceratite Dendrítica/diagnóstico , Idoso , Conjuntivite/etiologia , Diagnóstico Diferencial , Técnicas de Diagnóstico Oftalmológico , Oftalmopatias/diagnóstico , Medicina de Família e Comunidade , Humanos , Masculino , AnamneseRESUMO
Crystalline keratopathy can be successfully treated by the Nd:YAG laser. We present two cases of crystalline keratopathy managed this way. A 36-year-old female contact lens wearer presented with crystalline keratopathy following recent treatment with topical steroids and antibiotics for a corneal abscess. In this case crystalline keratopathy developed despite the intensive topical antibiotic treatment. A 55-year-old man with a history of acne rosacea, chronic myelomonocytic leukaemia, asthma and Crohn's disease presented with crystalline keratopathy following an episode of infectious keratitis. Treatment with the Nd:YAG laser to the area of involvement was instituted in both cases. Noticeable resolution occurred within days, with subsequent full recovery. No side-effects from the use of the Nd:YAG laser were noted. There have been only two cases previously reported using this treatment modality.
Assuntos
Biofilmes , Doenças da Córnea/cirurgia , Infecções Oculares Bacterianas/cirurgia , Terapia a Laser , Lasers de Estado Sólido/uso terapêutico , Infecções Estafilocócicas/cirurgia , Adulto , Doenças da Córnea/microbiologia , Doenças da Córnea/patologia , Substância Própria/microbiologia , Substância Própria/cirurgia , Infecções Oculares Bacterianas/microbiologia , Infecções Oculares Bacterianas/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infecções Estafilocócicas/microbiologia , Infecções Estafilocócicas/patologiaAssuntos
Conservadores da Densidade Óssea/efeitos adversos , Difosfonatos/efeitos adversos , Imidazóis/efeitos adversos , Celulite Orbitária/induzido quimicamente , Oftalmopatias/induzido quimicamente , Oftalmopatias/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Radiografia , Ácido ZoledrônicoRESUMO
Ipratropium bromide is a commonly used bronchodilator which has been rarely reported to cause pharmacological mydriasis. We report a 22-year-old woman using 6-hourly nebulised ipratropium from a multi-dose preparation, who presented with a unilateral dilated pupil which resolved spontaneously over 24h after discontinuation of her ill-fitting nebuliser mask which had been directing the drug toward that eye. No alternative cause was found despite extensive investigations. Greater recognition of this iatrogenic cause of reversible pupillary dilatation may avoid the need for unnecessary investigations.
Assuntos
Broncodilatadores/efeitos adversos , Ipratrópio/efeitos adversos , Midríase/etiologia , Adulto , Feminino , HumanosRESUMO
A 72-year-old lady was referred with bacterial endophthalmitis secondary to complicated left cataract extraction. The organism was identified as Serratia marcescens. Despite aggressive treatment the eye continued to deteriorate with corneal perforation and prolapse of the intraocular contents.
Assuntos
Doenças da Córnea/etiologia , Endoftalmite/etiologia , Infecções Oculares Bacterianas/etiologia , Migração de Corpo Estranho/etiologia , Lentes Intraoculares , Infecções por Serratia/etiologia , Serratia marcescens/isolamento & purificação , Idoso , Antibacterianos/uso terapêutico , Extração de Catarata/efeitos adversos , Doenças da Córnea/diagnóstico , Endoftalmite/diagnóstico , Endoftalmite/terapia , Evisceração do Olho , Infecções Oculares Bacterianas/diagnóstico , Infecções Oculares Bacterianas/terapia , Feminino , Migração de Corpo Estranho/diagnóstico , Humanos , Implante de Lente Intraocular , Ruptura Espontânea , Infecções por Serratia/diagnóstico , Infecções por Serratia/terapiaAssuntos
Antagonistas Adrenérgicos alfa/efeitos adversos , Complicações Intraoperatórias , Doenças da Íris/induzido quimicamente , Iris/efeitos dos fármacos , Facoemulsificação/métodos , Sulfonamidas/efeitos adversos , Antagonistas de Receptores Adrenérgicos alfa 1 , Antineoplásicos/efeitos adversos , Humanos , Doenças da Íris/prevenção & controle , Masculino , Hiperplasia Prostática/tratamento farmacológico , Síndrome , TansulosinaRESUMO
BACKGROUND: To compare temporal artery biopsy specimen lengths from a tertiary care and a community hospital in New South Wales to recommended clinical guidelines in suspected giant cell arteritis. DESIGN: A retrospective observational study of all patients who underwent temporal artery biopsy at Bathurst Base Hospital (BBH) and Royal Prince Alfred Hospital (RPAH) over a 5-year period. METHODS: Patients who underwent temporal artery biopsy during the 5-year period were identified using computerized hospital databases. A retrospective chart review was carried out on all cases. Data were collected regarding patient age, patient sex, length of biopsy specimen, histopathological results and surgical team carrying out the biopsy. RESULTS: During the 5-year period, 157 temporal artery biopsies were carried out at both hospitals, with 38/157(24%) at BBH and 119/157 (76%) at RPAH. There was no significant difference in biopsy length at the two hospitals. The mean specimen length at BBH was 12.1 mm compared with 11.7 mm at RPAH (t=0.35; P=0.73). At RPAH, there was no significant difference in specimen length between the surgical specialties carrying out the biopsy (ANOVA F=1.37; P=0.26). Specimens of length 20 mm or greater were 2.8 times more likely to show features of giant cell arteritis than those less than 20 mm. CONCLUSION: The mean length of temporal artery biopsy specimens at both hospitals was substantially shorter than recommended guidelines of a minimum 20 mm. We recommend all surgeons carrying out temporal artery biopsies ensure a specimen of sufficient length is obtained.
Assuntos
Biópsia/métodos , Artérias Temporais/patologia , Idoso , Feminino , Arterite de Células Gigantes/patologia , Humanos , Masculino , Guias de Prática Clínica como Assunto , Estudos RetrospectivosRESUMO
Hydroxyapatite orbital implants are widely used in enucleation surgery. Infection in this setting is an uncommon but severe complication. Herein a patient with a 3-year history of chronic socket discharge, orbital discomfort, conjunctival breakdown and implant exposure after enucleation and implantation of a hydroxyapatite sphere 7 years previously is reported. Repeated attempts at covering the exposed implant failed. Eventually the implant was removed, and Aspergillus fumigatus was cultured from the explanted material. This is the second reported case of Aspergillus infection of a hydroxyapatite orbital implant, and the first case where fungal cultures were positive.
Assuntos
Aspergilose/etiologia , Aspergillus fumigatus/isolamento & purificação , Durapatita , Infecções Oculares Fúngicas/etiologia , Implantes Orbitários/efeitos adversos , Infecções Relacionadas à Prótese/etiologia , Enucleação Ocular , Feminino , Humanos , Pessoa de Meia-Idade , Implantes Orbitários/microbiologia , ReoperaçãoRESUMO
PURPOSE: To investigate established pterygia using our newly developed ultraviolet fluorescence photography (UVFP) system. DESIGN: Prospective observational case series. METHODS: setting: Prince of Wales Hospital, Sydney, Australia. study population: Fourteen patients (both eyes) attending the Ophthalmology Clinic at Prince of Wales Hospital for assessment of their established pterygia. There were eight men and six women, with an age range of 26 to 62 years. A total of 15 (75%) of 20 had primary pterygia, and five (25%) of 20 had recurrent pterygia. There were no specific exclusion criteria. observation procedures: Ultraviolet and standard (control) photographs were taken of the nasal and temporal interpalpebral regions bilaterally. main outcome measures: The presence of established pterygia detected by standard photography and the corresponding presence and patterns of areas of fluorescence detected by UVFP. RESULTS: In the 14 patients, 20 established pterygia were identified on standard photography. On UVFP, four patterns of fluorescence of established pterygia were identified. Of the 20 pterygia, six (30%) of 20 demonstrated fluorescence at the leading edge of the pterygium, seven (35%) of 20 demonstrated fluorescence at the limbus, three (15%) of 20 demonstrated fluorescence at both the leading edge and the limbus, and four (20%) of 20 demonstrated no visible fluorescence. CONCLUSIONS: In this study, we describe patterns of fluorescence in established pterygia by UVFP. We hypothesize that the areas of fluorescence represent areas of cellular activity within the pterygium. The patterns of fluorescence may be useful to further understand of pterygium growth and pathogenesis.
Assuntos
Fluorescência , Fotografação/métodos , Pterígio/patologia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Pterígio/classificação , Raios UltravioletaRESUMO
PURPOSE: To develop a method to detect precursors of ocular sun damage using ultraviolet fluorescence photography (UVFP). DESIGN: Observational cross-sectional study METHODS: settings: Preschool, primary, and high school in Sydney, Australia. study population: 71 children ages 3 to 15 years old (both eyes). Inclusion criteria were children attending the schools who gave consent. There were no exclusion criteria. observation procedures: UV and standard (control) photographs were taken of the nasal and temporal interpalpebral regions bilaterally. main outcome measures: Presence of areas of increased fluorescence detected by UVFP, or presence of pinguecula detected by standard photography. RESULTS: Established pingueculae, on standard photography, were seen in seven of 71 (10%) children; all were 13 years of age or older. On UVFP, all of these pingueculae demonstrated fluorescence. In total, 23 of 71 (32%) had increased fluorescence detected on UVFP, including the seven of 23 (30%) with pingueculae. Of the remaining 16 of 23 (70%), the changes were only detectable using UVFP. Fluorescence on UVFP was seen in children ages 9 years and above, with prevalence increasing with age. The presence of fluorescence (in at least one region) was 0 of 15 (0%) for children ages 3 to 5 years, 0 of 12 (0%) of children ages 6 to 8 years, 6 of 23 (26%) for those ages 9 to 11 years, and 17 of 21 (81%) of those ages 12 to 15 years. CONCLUSIONS: We hypothesize that the areas seen to fluoresce on UVFP but not detectable on control photography represent precursors for ophthalmohelioses. Our preliminary data strongly suggests that UVFP is a sensitive method for detecting early ocular sun damage occurring many years before clinical manifestations.