RESUMEN
AIMS: There is evidence that altered retinal blood flow and altered retinal blood flow regulation play a role in the development and progression of diabetic retinopathy. We compared the association between systemic blood pressure and retinal white blood cell flux in patients with type 1 diabetes and healthy control subjects. METHODS: The study was performed in 100 patients with type 1 diabetes with no or minimal diabetic retinopathy and a group of 313 age-matched healthy controls. Inclusion criteria were systolic blood pressure ≤ 160 mmHg and diastolic blood pressure ≤ 95 mmHg. None of the subjects took vasoactive medication except insulin. The blue field entoptic technique was used to assess retinal white blood cell flux, velocity and density in the perimacular region. Pressure-flow relationships were calculated for both groups to assess differences in blood flow regulation. RESULTS: Retinal white blood cell flux was comparable between the two study groups. Both type 1 diabetic patients and healthy subjects showed a significant positive correlation between retinal white blood cell flux and mean arterial pressure (diabetic patients: r=0.48; p<0.05, healthy subjects r=0.28). The correlation coefficients between mean arterial pressure and white blood cell flux were significantly higher in patients with diabetes than in the healthy control group (p=0.0459). CONCLUSION: Retinal white blood cell flux, as assessed with the blue-field entoptic technique, is not significantly different between type 1 diabetic patients with no or minimal retinopathy and healthy control subjects. Type 1 diabetic subjects do, however, show an abnormal association between systemic blood pressure and retinal white blood cell flux. This indicates altered autoregulation in early diabetic retinopathy.
Asunto(s)
Presión Sanguínea/fisiología , Diabetes Mellitus Tipo 1/fisiopatología , Retinopatía Diabética/fisiopatología , Leucocitos/fisiología , Vasos Retinianos/fisiopatología , Adulto , Velocidad del Flujo Sanguíneo/fisiología , Glucemia/metabolismo , Femenino , Hemoglobina Glucada/metabolismo , Homeostasis , Humanos , Presión Intraocular/fisiología , Flujometría por Láser-Doppler , Masculino , Persona de Mediana Edad , Tonometría Ocular , Adulto JovenRESUMEN
PURPOSE: To investigate the macular changes following silicone oil removal after surgery for complicated retinal detachment (RD) with proliferative vitreoretinopathy (PVR). DESIGN: Retrospective interventional case series. METHODS: setting: Vienna, Austria. study population: Thirty-nine patients with attached retina after silicone oil removal following previous vitrectomy and silicone oil tamponade for complicated RD and PVR grade C3 and worse. observation procedures: Examination of macular anatomy with biomicroscopy, optical coherence tomography (OCT), and fluorescein angiography (FA). Macular function was tested by assessing logMAR distance visual acuity (VA) using Early Treatment Diabetic Retinopathy Study (ETDRS) charts and reading acuity and reading speed using a standardized test (Radner charts). main outcome measures: Macular anatomy, VA, reading acuity, and reading speed. RESULTS: The macula was clinically normal in five patients (12.8%). Retinal pigment epithelium (RPE) irregularities were found in nine patients (23.1%). Eight patients (20.5%) had macular pucker, seven (18.0%) had cystoid macular edema (CME), and 10 (25.6%) had subretinal fibrosis. The mean VA of all patients was logMAR 0.67 +/- 0.68 (range, -0.1 to 3.0). Six eyes did not achieve reading acuity. The distance VA of the remaining 33 eyes was logMAR 0.44 +/- 0.29 and their mean reading acuity was logRAD 0.62 +/- 0.35, with a reading speed ranging from 55 to 240 words per minute. CONCLUSIONS: We found macular changes in 87% of the patients, one-third thereof being eligible for further treatment (macular pucker or CME). Thus, the majority of these patients do not seem to be eligible for a further improvement of anatomic or functional outcome.
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Mácula Lútea/fisiopatología , Desprendimiento de Retina/fisiopatología , Vitrectomía , Vitreorretinopatía Proliferativa/fisiopatología , Drenaje/métodos , Angiografía con Fluoresceína , Humanos , Microscopía Acústica , Desprendimiento de Retina/complicaciones , Desprendimiento de Retina/cirugía , Estudios Retrospectivos , Aceites de Silicona , Tomografía de Coherencia Óptica , Agudeza Visual/fisiología , Vitreorretinopatía Proliferativa/complicaciones , Vitreorretinopatía Proliferativa/cirugíaRESUMEN
PURPOSE: To analyze the clinical outcome of treatment with aflibercept in patients not responding to ranibizumab and bevacizumab. METHODS: Retrospective review of 32 eyes from 30 consecutive patients with choroidal neovascularization (CNV) who showed no response to treatment with ranibizumab or bevacizumab and were switched to aflibercept. Visual acuity, central macular thickness (CMT) and presence or absence of intraretinal or subretinal fluid were analyzed before switching to aflibercept, after each of three uploading dose injections of aflibercept and 6, 8 and 10 weeks after the third aflibercept injection. All eyes had previous ranibizumab injections and the mean number of previous injections was 14.75 (± 7.38). Mean duration of previous anti-vascular endothelial growth factor (VEGF) treatment was 38 months (± 27.35 months). RESULTS: Mean visual acuity before switching to aflibercept was 0.40 ± 0.30 logMAR. After the third injection visual acuity was 0.3 ± 0.3 logMAR and 10 weeks after the third injection it was 0.50 ± 0.20 logMAR. No significant differences were seen during treatment and follow-up. The mean CMT was 394 ± 118 µm at baseline, at follow-up (first, second and third, group week 6, group week 8 and group week 10) it was 317 ± 108 µm, 301 ± 99 µm, 292 ± 83 µm, 270 ± 78 µm, 340 ± 146 µm and 377 ± 92 µm, respectively. Significant reductions in CMT were seen between the first and third follow-up injections and at group week 8. Of the patients 59.4 % were complete non-responders to aflibercept. CONCLUSION: Aflibercept results in improvement in CMT in non-responders to ranibizumab and bevacizumab as long as therapy is given continuously and can therefore be an alternative therapy.
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Bevacizumab/administración & dosificación , Neovascularización Coroidal/diagnóstico , Neovascularización Coroidal/tratamiento farmacológico , Mácula Lútea/efectos de los fármacos , Ranibizumab/administración & dosificación , Receptores de Factores de Crecimiento Endotelial Vascular/administración & dosificación , Proteínas Recombinantes de Fusión/administración & dosificación , Agudeza Visual/efectos de los fármacos , Anciano , Anciano de 80 o más Años , Inhibidores de la Angiogénesis/administración & dosificación , Neovascularización Coroidal/patología , Sustitución de Medicamentos , Femenino , Humanos , Mácula Lútea/patología , Masculino , Tamaño de los Órganos/efectos de los fármacos , Estudios Retrospectivos , Insuficiencia del Tratamiento , Resultado del TratamientoRESUMEN
BACKGROUND: Glaucoma is a chronic and serious disease calling for consistent lifelong therapy. The patient's compliance requires that he/she be well informed about the disease. The purpose of the present study was to determine the level of knowledge about glaucoma, and compare young patients with older ones as well as glaucoma patients with nonglaucoma ones. METHODS: A total of 1110 questionnaires were distributed to patients and their relatives at the outpatient eye clinic of Hietzing Hospital (Vienna), of which 1041 were returned. The questionnaire comprised 18 questions. Patients were divided into two groups: group 1 consisted of those aged 18-60 years, while group 2 consisted of those older than 61 years. RESULTS: In total, 941 questionnaires were evaluated; 72.8% of the respondents were older than 60 years, and one-half of the respondents had glaucoma (51%). The majority of patients had "moderate knowledge" of the disease (41.87%), followed by "poor knowledge" (32.52%). Glaucoma patients had considerably better knowledge of the disease (p < 0.01) than did nonglaucoma patients. Younger patients were significantly better informed than older ones (p < 0.01). Nonglaucoma patients with a positive diagnosis of glaucoma among their circle of friends or family were significantly better informed (p < 0.01) than those without such persons in their circle of friends. CONCLUSION: Persons with glaucoma are much better informed about the disease than nonglaucoma patients, but the general level of knowledge is very low. Notably, younger patients were better informed than older ones. The present study, comprising a large number of patients, revealed poor knowledge of glaucoma among patients with the disease and especially among nonglaucoma patients in Vienna.
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Familia , Glaucoma/epidemiología , Conocimientos, Actitudes y Práctica en Salud , Alfabetización en Salud/estadística & datos numéricos , Educación del Paciente como Asunto/estadística & datos numéricos , Adolescente , Adulto , Distribución por Edad , Anciano , Anciano de 80 o más Años , Austria/epidemiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Distribución por Sexo , Encuestas y Cuestionarios , Adulto JovenRESUMEN
PURPOSE: To investigate the influence of various types of cataract on reading performance in a standardized reading test setting. SETTING: Department of Ophthalmology, University of Vienna, Vienna, Austria. METHODS: The reading performance of 94 eyes with age-related cataract and normal macular function was evaluated with the Radner Reading Charts preoperatively and 4 weeks after cataract surgery. Distance visual acuity was tested with the ETDRS charts. Cataracts were graded using the Lens Opacities Classification System (LOCS) III, on which NO is nuclear opalescence and NC is nuclear color. RESULTS: Patients with pure nuclear cataracts (LOCS III: NO/NC 2.1-5) achieved a normally high MRS (99.84% +/- 7.65% of their postoperative MRS): preoperative MRS(1): 190.6 +/- 30.74 words per minute (wpm); postoperative MRS(2): 191.21 +/- 29.36 wpm. Patients with mixed nuclear-cortical cataracts (LOCS III: NO/NC 2.1-5; C>2) preoperatively achieved 96.96% +/- 5.6% of their postoperative MRS (MRS(1): 175.77 +/- 31.54 wpm; MRS(2): 181.34 +/- 30.56 wpm). In dense nuclear cataracts (LOCS III: NO/NC>5), the MRS was significantly reduced, achieving only 72.64 +/- 19.19% of the postoperative MRS (MRS(1): 133.06 +/- 39.43 wpm; MRS(2): 185.76 +/- 40.18 wpm). In posterior subcapsular cataracts, the preoperative MRS (134.1 +/- 33.72 wpm) was significantly lower than postoperatively (191.14 +/- 27.08 wpm). CONCLUSIONS: In contrast to dense nuclear cataracts and posterior subcapsular cataracts, the preoperative reading speed of patients with pure nuclear or nuclear-cortical cataracts was normal at large print sizes. The preoperative evaluation of reading acuity and speed with standardized reading tests can therefore be used to estimate the postoperative reading performance in the latter 2 types of cataract.
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Catarata/fisiopatología , Lectura , Anciano , Catarata/clasificación , Humanos , Persona de Mediana Edad , Facoemulsificación , Estudios Prospectivos , Trastornos de la Visión/fisiopatología , Pruebas de Visión/instrumentación , Agudeza VisualRESUMEN
PURPOSE: To evaluate treatment of macular oedema due to central retinal vein occlusion (CRVO) with intravitreal triamcinolone acetonide. METHODS: In a prospective case series, 13 patients with macular oedema due to non-ischaemic CRVO received an intravitreal injection of 4 mg triamcinolone acetonide. Examination included assessment of best corrected visual acuity (BCVA) for distance and reading, measurement of intraocular pressure (IOP), fluorescein angiography and high resolution imaging by optical coherence tomography, preoperatively and 1 week, 1 month, 3, 6 and 9 months postoperatively. RESULTS: Preoperative mean BCVA was 0.9 +/- 0.4 for distance vision and 1.0 +/- 0.3 for reading acuity, respectively. A significant improvement in distance VA (0.5 +/- 0.3, p < 0.001) and reading acuity (0.7 +/- 0.3, p = 0.03) was observed until 3 months and 6 months, respectively. Mean macular thickness was significantly reduced until 9 months postoperatively. CONCLUSION: Intravitreal injection of triamcinolone acetonide led to a significant improvement in mean VA in patients with macular oedema due to CRVO. However, the significant effect was not permanent and persisted for a maximum of 6 months.
Asunto(s)
Glucocorticoides/uso terapéutico , Edema Macular/tratamiento farmacológico , Oclusión de la Vena Retiniana/tratamiento farmacológico , Triamcinolona Acetonida/uso terapéutico , Angiografía con Fluoresceína , Estudios de Seguimiento , Glucocorticoides/administración & dosificación , Glucocorticoides/efectos adversos , Humanos , Inyecciones , Presión Intraocular/fisiología , Edema Macular/etiología , Edema Macular/fisiopatología , Persona de Mediana Edad , Estudios Prospectivos , Oclusión de la Vena Retiniana/complicaciones , Oclusión de la Vena Retiniana/fisiopatología , Tomografía de Coherencia Óptica , Triamcinolona Acetonida/administración & dosificación , Triamcinolona Acetonida/efectos adversos , Agudeza Visual/fisiología , Cuerpo VítreoRESUMEN
PURPOSE: To evaluate treatment of macular oedema due to branch retinal vein occlusion (BRVO) with intravitreal triamcinolone acetonide. METHODS: In a prospective case series, nine patients with macular oedema due to BRVO received an intravitreal injection of 4 mg triamcinolone acetonide. Examination included best-corrected visual acuity (BCVA) for distance and reading, intraocular pressure (IOP) measurement, fluorescein angiography and high resolution imaging by optical coherence tomography, preoperatively and at 1 week, 1 month, 3 and 6 months postoperatively. RESULTS: Preoperative mean BCVAs were 1.3 +/- 0.8 for distance vision, and 1.1 +/- 0.3 for reading acuity, respectively. A significant improvement in reading acuity was observed until 1 month (0.7 +/- 0.4, p = 0.02). No significant reduction in mean macular thickness was observed. CONCLUSIONS: Intravitreal injection of triamcinolone acetonide led to a significant improvement in mean VA in patients with macular oedema due to BRVO. However, the significant effect was not permanent and persisted for only 1 month.
Asunto(s)
Glucocorticoides/uso terapéutico , Edema Macular/tratamiento farmacológico , Oclusión de la Vena Retiniana/tratamiento farmacológico , Triamcinolona Acetonida/uso terapéutico , Anciano , Angiografía con Fluoresceína , Glucocorticoides/administración & dosificación , Humanos , Inyecciones , Presión Intraocular/fisiología , Edema Macular/etiología , Edema Macular/fisiopatología , Proyectos Piloto , Estudios Prospectivos , Oclusión de la Vena Retiniana/complicaciones , Oclusión de la Vena Retiniana/fisiopatología , Tomografía de Coherencia Óptica , Triamcinolona Acetonida/administración & dosificación , Agudeza Visual/fisiología , Cuerpo VítreoRESUMEN
BACKGROUND: The purpose of this study was to analyze statistically the test-retest and inter-chart reliability of three standardized Radner Reading Charts with respect to reading acuity, maximum reading speed, critical print size and LogRAD/LogMAR ratio and to quantitatively identify the sources of variability. METHODS: At two testing sessions (3 to 4 weeks apart), 36 volunteers read monocularly all three Radner Reading Charts in randomized order (orthogonal Latin square design). The subjects were grouped according to their distance LogMAR visual acuity (group 1, 0.1 or better; group 2, 0.12-0.4; group 3, 0.42-0.8). Based on these 216 reading tests, crude correlations were calculated between the two testing sessions and between the three charts, and "variance component analyses" were performed for all variables. RESULTS: For all visual acuity groups and variables, the test-retest and the inter-chart reliability was high. The variance component analyses showed that the differences between individuals predominantly influenced the variance, whereas the effect of the test replication was low. The three charts caused minimal variability, indicating equality for clinical examinations. CONCLUSION: The standardized Radner Reading Charts provide clinically reliable and reproducible results for individuals with normal eyesight and for patients with visual impairment. These findings indicate that reading test systems, which consider the current international standards for visual acuity measurements (EN ISO 8596, NAS-NRC) and the psychophysical requirements for controlling optical item interactions, can provide reliable measures for clinical and scientific analyses of reading performance.