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1.
Surv Ophthalmol ; 2024 Apr 10.
Artigo em Inglês | MEDLINE | ID: mdl-38609022

RESUMO

Corneal epithelial defects are one of the most common ocular disorders. Restoring corneal integrity is crucial to reduce pain and regain function, but in cases of neurotrophic or desensitized corneas, healing can be significantly delayed. Treating neurotrophic corneas is challenging for ophthalmologists, and surgical intervention is often indicated to manage refractory cases that are unresponsive to medical therapy. Over the last decade, as more expensive therapeutics reach the market, topical insulin has returned to the forefront as an affordable option to improve corneal wound healing. There is still a paucity of data on the use and the efficacy of topical insulin, with no consensus regarding its indications, preparation, or posology. Here we review the literature on topical insulin for corneal and ocular surface pathologies, with a focus on the current evidence, its mechanisms of action, and its safety profile. Additionally, we share our experience in the field and provide a potential framework for future research.

2.
BMJ Open ; 13(9): e072333, 2023 09 15.
Artigo em Inglês | MEDLINE | ID: mdl-37714670

RESUMO

OBJECTIVES: Corneal blindness is the third most frequent cause of blindness globally. Damage to the corneal endothelium is a leading indication for corneal transplantation, which is typically performed by lamellar endothelial keratoplasty. There are two conventional surgical techniques: Ultra-Thin Descemet Stripping Automated Endothelial Keratoplasty (UT-DSAEK) and Descemet Membrane Endothelial Keratoplasty (DMEK). The purpose of this study is to compare both techniques. METHODS AND ANALYSIS: The trial compares UT-DSAEK and DMEK in terms of clinical and patient reported outcomes using a pragmatic, parallel, multicentric, randomised controlled trial with 1:1 allocation with a sample size of 220 participants across 11 surgical centres. The primary outcome is the change in best-corrected visual acuity at 12 months. Secondary outcomes include corrected and uncorrected vision, refraction, proportion of high vision, quality of life (EQ-5D-5L and VFQ25), endothelial cell counts and corneal thickness at 3, 6 and 12 months follow-up appointments. Adverse events will also be compared 12 months postoperatively. ETHICS AND DISSEMINATION: The protocol was reviewed by ethical committees of 11 participating centres with the sponsor centre issuing the final definitive approval. The results will be disseminated at clinical conferences, by patient partner groups and open access in peer-reviewed journals. GOVERNANCE OF THE TRIAL: Both, trial management group and trial steering committee, are installed with representatives of all stakeholders involved including surgeons, corneal bankers, patients and external experts. TRIAL REGISTRATION NUMBER: NCT05436665.


Assuntos
Doenças da Córnea , Transplante de Córnea , Humanos , Endotélio Corneano/cirurgia , Bélgica , Lâmina Limitante Posterior , Qualidade de Vida , Doenças da Córnea/cirurgia , Córnea , Medidas de Resultados Relatados pelo Paciente , Cegueira , Ensaios Clínicos Controlados Aleatórios como Assunto
3.
Sleep Med ; 84: 308-316, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34217921

RESUMO

BACKGROUND: Sleep disturbances are features of Parkinson's disease (PD), that can already occur before PD diagnosis. The most investigated prodromal PD sleep disorder is REM sleep behavior disorder (RBD). The relation between other polysomnographic (PSG) alterations and the prediagnostic stages of PD, however, is less clear. METHODS: We performed a retrospective case-control study to characterize polysomnographic alterations in PD and prediagnostic PD. We included 63 PD subjects (33 subjects that underwent a video-PSG before PD diagnosis [13 with and 20 without RBD] and 30 subjects that underwent a PSG after PD diagnosis) and 30 controls. PSGs were analyzed for sleep stages, different RSWA variables, body position, arousals, periodic limb movements, and REM density. RESULTS: Higher subscores of all RSWA variables were observed in subjects with PD and prediagnostic PD (with and without RBD). Total RSWA, tonic RSWA and chin RSWA severity were significant predictors for all PD and prediagnostic PD groups. Our study also shows a higher percentage of nocturnal supine body position in all PD and prediagnostic PD groups. Supine body position percentage is the highest in the PD group and has a positive correlation with time since diagnosis. CONCLUSIONS: These findings suggest that increased total, tonic and chin RSWA as well as nocturnal supine body position are already present in prediagnostic PD, independently of RBD status. Prospective longitudinal studies are necessary to confirm the additional value of these PSG abnormalities as prodromal PD biomarkers.


Assuntos
Doença de Parkinson , Transtorno do Comportamento do Sono REM , Estudos de Casos e Controles , Humanos , Doença de Parkinson/complicações , Doença de Parkinson/diagnóstico , Estudos Prospectivos , Transtorno do Comportamento do Sono REM/diagnóstico , Estudos Retrospectivos , Sono REM
4.
Parkinsonism Relat Disord ; 67: 90-98, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31326237

RESUMO

REM sleep without atonia (RSWA) is the polysomnographic finding of persistent muscle tone during REM sleep, resulting in paroxysmal phasic or tonic EMG activity. RSWA is essential for the diagnosis of REM sleep behavior disorder (RBD), but can also occur without dream-enacting behavior. Loss of atonia during REM sleep is considered as a biomarker for synucleinopathies. We will give an overview of the pathophysiology of RSWA and will highlight the diagnostic methods for RSWA. We will describe the different etiologies of RSWA and finally we will focus on the role of RSWA as biomarker for Lewy body disease. RSWA severity in isolated RBD patients is a potential predictor for early conversion to Parkinson's disease (PD) or dementia with Lewy bodies. In PD patients, RSWA severity is associated with more severe motor symptoms and disease progression. Future studies are needed to delineate the importance of isolated RSWA as prodromal marker of Lewy body disease.


Assuntos
Doença por Corpos de Lewy/fisiopatologia , Doença de Parkinson/fisiopatologia , Sintomas Prodrômicos , Parassonias do Sono REM/fisiopatologia , Progressão da Doença , Eletromiografia , Medições dos Movimentos Oculares , Humanos , Narcolepsia/fisiopatologia , Doenças Neurodegenerativas/fisiopatologia , Polissonografia , Transtorno do Comportamento do Sono REM/fisiopatologia , Parassonias do Sono REM/diagnóstico , Índice de Gravidade de Doença , Sinucleinopatias/fisiopatologia , Tauopatias/fisiopatologia
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