Influence of the dilution method on the intraocular duration of C3F8 in vitrectomy for macular hole: a randomized clinical trial.

PURPOSE: To compare the injection of small amounts of undiluted C3F8 with the traditional gas injection in vitrectomy for macular hole treatment. METHODS: This clinical trial included 26 individuals divided into two groups. Group 1 received an intravitreal injection of 0.9-1.0 mL of 100% C3F8, and Group 2 received 15-20 mL of 20% C3F8. RESULTS: The median intraocular gas duration was 31 days in Group 1 and 34 in Group 2. The median letter gains in corrected distance visual acuity for the 26th postoperative week were 20 letters in Group 1 and 12.5 in Group 2. The median intraocular pressure was normal in both groups. Primary anatomical success was 11/13 in both groups. CONCLUSIONS: The use of C3F8 gas in a small undiluted volume is an alternative that slightly reduces the duration of the gas without negatively affecting the anatomical and visual response.

Firework-related ocular trauma in Pernambuco, Brazil / Trauma ocular por fogos de artifício em Pernambuco, Brasil

ABSTRACT Purpose: This study aimed to describe the demographic and clinical characteristics of victims of fireworkrelated ocular trauma treated at the ophthalmologic emergency de partments of two reference centers in Pernambuco, Brazil, and to identify risk factors related to poor visual prognosis. Methods: We retrospectively evaluated the medical records of patients admitted in emergency departments with a report of firework-related trauma between January 2012 and December 2018. Data collected included patient's age, sex, place of origin, month and year of the accident, ocular structures affected, characteristics of the injuries, and type of treatment that patients received. For patients who were followed for >30 days, the final visual acuity and patient's origin were analyzed. Results: Three hundred and seventy eyes from 314 patients were included, of which 248 (79.0%) were male and 160 (51.0%) were from the metropolitan region of Recife. The mean patient age was 25.6 ± 18.8 years. In 56 (17.8%) patients, the ocular trauma was bilateral. A total of 152 (48.4%) cases occurred in June. The most affected sites were the eyelids in 91 (24.6%) eyes and ocular surface in 252 (68.1%). Surgical treatment was required in 87 (23.5%) eyes. After clinical and surgical management, 37 (10.0%) eyes presented final visual acuity of <20/400. Of these, 34 (91.9%) eyes were from patients from the countryside or from another state. Patients from the countryside presented higher risk of developing blindness after a firework trauma than those from the metropolitan area (odds ratio of 5.46). Conclusions: Victims of firework-related ocular trauma were mostly male, from the metropolitan region of Pernambuco state and mainly pediatric patients or economically active. Those coming from the countryside and other states had higher risk of developing blindness

RESUMO Objetivos: Descrever as características demográficas e clínicas das vítimas de trauma ocular por fogos de artifício atendidas nas emergências oftalmológicas de dois centros de referência em Pernambuco e identificar fatores relacionados a mau prognóstico visual. Métodos: Avaliação retrospectiva dos prontuários de pacientes admitidos na emergência oftalmológica com história de trauma por fogos de artifício entre janeiro de 2012 e dezembro de 2018. A coleta de dados incluiu idade, gênero, procedência, mês e ano do acidente, estruturas oculares acometidas e características das lesões, além do tipo de tratamento a que os pacientes foram submetidos. Naqueles pacientes acompanhados por mais de 30 dias, analisou-se a acuidade visual final e a associação com sua procedência. Resultados: Foram incluídos 370 olhos de 314 pacientes. Destes, 248 (79,0%) vítimas eram do sexo masculino e 160 (51,0%) da região metropolitana do Recife, com uma média de idade de 25.6 ± 18.8 anos. Em 56 (17,8%) dos casos o trauma foi bilateral. No mês de junho ocorreu um total de 152 (48,4%) casos. Os sítios mais acometidos foram pálpebras em 91 (24,6%) olhos e superfície ocular em 252 (68,1%). O tratamento cirúrgico foi necessário em 87 (23,5%) olhos. Após manejo clínico-cirúrgico, 37 (10.0%) olhos desenvolveram visão pior do que 20/400. Destes, 34 (91,9%) olhos eram de pacientes do interior do estado de Pernambuco ou de outro estado. Os pacientes provenientes do interior do estado apresentaram maior chance de desenvolver cegueira quando comparados aos que eram provenientes da região metropolitana (Odds Ratio de 5,46). Conclusões: As vítimas de trauma ocular por fogos de artificio foram em sua maioria do sexo masculino, procedentes da região metropolitana do estado e das faixas etárias pediátrica e economicamente ativa. Aqueles provenientes do interior ou de outros estados apresentaram maior chance de desenvolver cegueira.

Influence of the dilution method on the intraocular duration of C3F8 in vitrectomy for macular hole: a randomized clinical trial

ABSTRACT Purpose: To compare the injection of small amounts of undiluted C3F8 with the traditional gas injection in vitrectomy for macular hole treatment. Methods: This clinical trial included 26 individuals divided into two groups. Group 1 received an intravitreal injection of 0.9-1.0 mL of 100% C3F8, and Group 2 received 15-20 mL of 20% C3F8. Results: The median intraocular gas duration was 31 days in Group 1 and 34 in Group 2. The median letter gains in corrected distance visual acuity for the 26th postoperative week were 20 letters in Group 1 and 12.5 in Group 2. The median intraocular pressure was normal in both groups. Primary anatomical success was 11/13 in both groups. Conclusions: The use of C3F8 gas in a small undiluted volume is an alternative that slightly reduces the duration of the gas without negatively affecting the anatomical and visual response.

Long-term outcomes of intraoperative triamcinolone injection versus postoperative oral prednisolone in congenital cataract surgery / Resultados de longo prazo do uso intraoperatório de triancinolona versus oral pós-operatório de prednisolona na cirurgia de catarata congênita

ABSTRACT Purpose: To compare the long-term ocular findings of children that were operated of congenital cataract before the age of two and that received an intraoperative intracameral triamcinolone injection or used postoperative oral prednisolone to modulate ocular inflammation. Methods: All patients who had previously participated in a clinical trial that analyzed the 1-year surgical outcomes of congenital cataract surgery utilizing intracameral triamcinolone (study group) or oral prednisolone (control group) were eligible to participate in this prospective cohort research. Patients' medical records were reviewed, and the children underwent a complete ophthalmologic exam on final follow-up. Biomicroscopic findings, intraocular pressure, central corneal thickness, the need for additional surgical interventions, and findings compatible with glaucoma were the primary end measures. Results: Twenty-six eyes (26 patients) were included (study group = 11 eyes; control group = 15 eyes). The mean follow--up was 8.2 ± 1.2 years and 8.1 ± 1.7 years in the study and control groups, respectively (p=0.82). All eyes presented a centered intraocular lens. There was no statistically significant difference between the groups with regards to the presence of posterior synechia (p=0.56), intraocular pressure (p=0.49), or central corneal thickness (p=0.21). None of the eyes fulfilled the glaucoma diagnostic criteria, presented secondary visual axis obscuration, or were reoperated. Conclusion: The long--term ocular findings of children that underwent congenital cataract surgery and received an intraoperative intracameral triamcinolone injection were similar to those that used postoperative oral prednisolone to modulate ocular inflammation. This suggests that intracameral triamcinolone may substitute oral prednisolone in congenital cataract surgery, facilitating the postoperative treatment regimen and compliance.

RESUMO Objetivo: Comparar os achados oculares em longo prazo de crianças que se submeteram à cirurgia de catarata congênita antes dos dois anos de idade e receberam uma injeção intracameral de triancinolona no intraoperatório ou usaram prednisolona oral no pós-operatório para modular a inflamação ocular. Métodos: Neste estudo prospectivo de coorte, todos os pacientes que participaram de um ensaio clínico anterior, que analisou os resultados cirúrgicos de 1 ano da cirurgia de catarata congênita usando triancinolona intracameral (Grupo de Estudo) ou prednisolona oral (Grupo Controle), eram elegíveis para participar. Os prontuários médicos dos pacientes foram revisados e as crianças foram submetidas a um exame oftalmológico completo no acompanhamento final. As principais medidas de desfecho foram: achados biomicroscópicos, pressão intraocular, espessura central da córnea, a necessidade de intervenções cirúrgicas adicionais e achados compatíveis com glaucoma. Resultados: Vinte e seis olhos (26 pacientes) foram incluídos (Grupo de Estudo = 11 olhos; Grupo de Controle = 15 olhos). O seguimento médio foi de 8,2 ± 1,2 anos e 8,1 ± 1,7 anos nos Grupos de Estudo e Controle, respectivamente (p=0,82). Todos os olhos apresentavam lente intraocular centrada. Não houve diferença estatisticamente significativa entre os grupos com relação à presença de sinéquia posterior (p=0,56), pressão intraocular (p=0,49) ou espessura central da córnea (p=0,21). Nenhum dos olhos preencheu os critérios diagnósticos para glaucoma, apresentou opacificação secundária do eixo visual ou foi reoperado. Conclusão: Os achados oculares em longo prazo de crianças que se submeteram à cirurgia de catarata congênita e receberam uma injeção intracameral de triancinolona no intraoperatório foram semelhantes aos que usaram prednisolona oral no pós-operatório para modular a inflamação ocular, sugerindo que a triancinolona intracameral pode substituir a prednisolona oral na cirurgia de catarata congênita, facilitando o tratamento pós-operatório e a adesão ao mesmo.

Firework-related ocular trauma in Pernambuco, Brazil.

PURPOSE: This study aimed to describe the demographic and clinical characteristics of victims of fireworkrelated ocular trauma treated at the ophthalmologic emergency de partments of two reference centers in Pernambuco, Brazil, and to identify risk factors related to poor visual prognosis. METHODS: We retrospectively evaluated the medical records of patients admitted in emergency departments with a report of firework-related trauma between January 2012 and December 2018. Data collected included patient's age, sex, place of origin, month and year of the accident, ocular structures affected, characteristics of the injuries, and type of treatment that patients received. For patients who were followed for >30 days, the final visual acuity and patient's origin were analyzed. RESULTS: Three hundred and seventy eyes from 314 patients were included, of which 248 (79.0%) were male and 160 (51.0%) were from the metropolitan region of Recife. The mean patient age was 25.6 ± 18.8 years. In 56 (17.8%) patients, the ocular trauma was bilateral. A total of 152 (48.4%) cases occurred in June. The most affected sites were the eyelids in 91 (24.6%) eyes and ocular surface in 252 (68.1%). Surgical treatment was required in 87 (23.5%) eyes. After clinical and surgical management, 37 (10.0%) eyes presented final visual acuity of <20/400. Of these, 34 (91.9%) eyes were from patients from the countryside or from another state. Patients from the countryside presented higher risk of developing blindness after a firework trauma than those from the metropolitan area (odds ratio of 5.46). CONCLUSIONS: Victims of firework-related ocular trauma were mostly male, from the metropolitan region of Pernambuco state and mainly pediatric patients or economically active. Those coming from the countryside and other states had higher risk of developing blindness.

Brow Lift Through The Upper Blepharoplasty Incision: Prospective Clinical Study.

BACKGROUND: Eyebrow tail ptosis is usually associated with dermatochalasis of the upper eyelid, and it is necessary to treat them together. For these associated procedures to be incorporated as a routine in upper eyelid surgeries, they should preferably be less invasive with consequent fewer complications. OBJECTIVE: We describe a minimally invasive technique for the correction of mild-to-moderate eyebrow tail ptosis corrected together with superior dermatochalasis through the blepharoplasty incision. METHODS: A phase 2 clinical trial was conducted from February 2020 to December 2021. A total of 50 patients underwent conventional upper blepharoplasty surgery associated with the proposed eyebrow lift technique: internal pexia in the periosteum, dissection, and posterior fixation of the orbicularis muscle to the arcus marginalis, removal of the lateral part of the orbicularis muscle, and loosening of the orbital retention ligament. Evaluation of the height of the eyebrow tail was performed with digital photography in the initial consultation and at 30-90 days postoperatively and analyzed with ImageJ software. RESULTS: Mean difference in brow height at 1-month and 3-month postoperative evaluations compared to the preoperative period was 3.45-3.33 mm, respectively. CONCLUSION: Our study demonstrated a minimally invasive surgical technique for the treatment of mild-to-moderate eyebrow ptosis with significant eyebrow tail lift results that remained stable during the study period. LEVEL OF EVIDENCE II: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Comparison of Retinal Structure Using Optical Coherence Tomography Angiography between Persons with and without HIV Infection.

HIV retinal microangiopathy is an important predictor for increased risk of mortality. Optical coherence tomography angiography (OCTA) can investigate microvascular changes resulting from retinal diseases. Study included 25 persons with HIV and 25 healthy persons. OCTA evaluated the vascularization of retinal layers, choriocapillary, and optic disk. HIV group had lower vessel flow density (VFD) in superficial plexus. No difference was observed in the deep plexus. VFD of the optic disk and peripapillary region showed no difference between the groups. HIV group showed a thinner retinal nerve fiber layer and smaller area of the optic disk rim. HIV infection is associated with VFD reduction in superficial retinal plexus, neural rim area reduction, and retinal nerve fiber layer thinning in individuals without microangiopathic alterations on fundus examination. Therefore, OCTA can find retinal changes before clinical evidence of retinopathy.

Association between axial length and level of education in elderly patients with cataracts unexposed to electronic devices in the first two decades of life / Associação entre diâmetro axial e nível educacional em pacientes idosos com catarata não expostos a dispositivos eletrônicos nas duas primeiras décadas de vida

ABSTRACT Purpose: To determine whether the axial length is associated with the education level in elderly patients with cataracts who were not exposed to electronic devices in the first two decades of life. Methods: This cross-sectional study was conducted in elderly patients with cataracts in Campinas, Brazil. Patients were divided into 2 groups: Group 1 included those who completed, at most, elementary school (including the illiterate and those who partially or totally attended elementary school), which corresponded to 12 years of schooling; Group 2 included, at least, high school graduates (including those who completed high school and those who partially or fully attended university). The sample was selected randomly with stratification for sex and age. The main outcome was the axial length. Results: The sample consisted of 472 elderly patients (236 per group) who underwent cataract surgery. There were 272 (57.6%) men and 200 (42.4%) women; the distribution was symmetrical between the two groups. The median age (IQR; range) was 66 (12; 50-89) years. The median axial length (IQR; range) was 22.82 (1.51; 20.34-28.71) mm in Group 1 and 23.32 (1.45; 20.51-31.34) mm in Group 2 (p<0.001). Conclusion: A greater axial length was associated with a higher level of education in elderly patients with cataracts, suggesting that myopization is related to an increase in activities requiring near-vision even before exposure to electronic devices.

RESUMO Objetivo: Determinar se o diâmetro axial está asso­ciado ao nível educacional em pacientes idosos com catarata que não foram expostos a dispositivos eletrônicos nas duas primeiras décadas de vida. Métodos: Este estudo transversal foi conduzido em pacientes idosos com catarata na cidade de Campinas, Brasil. Os Pacientes foram divididos em 2 grupos: no Grupo 1 foram incluídos aqueles que completaram, pelo menos, o ensino fundamental (incluindo analfabetos e aqueles com ensino fundamental completo ou incompleto), o que corresponde a 12 anos de escolaridade; no Grupo 2 foram incluídos indivíduos que, pelo menos, estudaram até o ensino médio (incluindo indivíduos com ensino médio completo e superior completo ou superior incompleto). A amostra foi selecionada aleatoriamente com estratificação por sexo e idade. O desfecho principal foi a medida do diâmetro axial. Resultados: A amostra foi constituída por 472 indivíduos que foram submetidos a cirurgia de catarata. Duzentos e trinta e seis indivíduos (50%) foram alocados no Grupo 1 e duzentos e trinta e seis indivíduos (50%) no Grupo 2. A mediana da idade (IIQ; intervalo) foi 66 (12; 50-89) anos. Duzentos e setenta e dois (57,6%) eram homens e duzentos (42,4%) mulheres, com distribuição simétrica entre os dois grupos. A mediana do diâmetro axial (IIQ; intervalo) foi 22,82 (1,51; 20,34-28,71) mm no Grupo 1 e 23,32 (1,45; 20,51-31,34) mm no Grupo 2 (p<0,001). Conclusão: Maiores medidas de diâmetro axial foram asso­ciadas a níveis educacionais mais elevados em pacientes idosos submetidos a cirurgia de catarata. Tal achado sugere que a miopização relacionada ao aumento de atividades que utilizam a visão de perto é fenômeno que ocorre antes mesmo da exposição a dispositivos eletrônicos.

Association between axial length and level of education in elderly patients with cataracts unexposed to electronic devices in the first two decades of life.

PURPOSE: To determine whether the axial length is associated with the education level in elderly patients with cataracts who were not exposed to electronic devices in the first two decades of life. METHODS: This cross-sectional study was conducted in elderly patients with cataracts in Campinas, Brazil. Patients were divided into 2 groups: Group 1 included those who completed, at most, elementary school (including the illiterate and those who partially or totally attended elementary school), which corresponded to 12 years of schooling; Group 2 included, at least, high school graduates (including those who completed high school and those who partially or fully attended university). The sample was selected randomly with stratification for sex and age. The main outcome was the axial length. RESULTS: The sample consisted of 472 elderly patients (236 per group) who underwent cataract surgery. There were 272 (57.6%) men and 200 (42.4%) women; the distribution was symmetrical between the two groups. The median age (IQR; range) was 66 (12; 50-89) years. The median axial length (IQR; range) was 22.82 (1.51; 20.34-28.71) mm in Group 1 and 23.32 (1.45; 20.51-31.34) mm in Group 2 (p<0.001). CONCLUSION: A greater axial length was associated with a higher level of education in elderly patients with cataracts, suggesting that myopization is related to an increase in activities requiring near-vision even before exposure to electronic devices.

Comparison Between Nylon and Polyglactin Sutures in Pediatric Cataract Surgery: A Randomized Controlled Clinical Trial.

Purpose: To compare the performance of nylon sutures to that of polyglactin sutures in pediatric patients undergoing cataract surgery. Setting: University of Campinas (UNICAMP), Campinas, São Paulo, Brazil Design: A prospective, randomized, partially masked, single-site clinical trial. (https://clinicaltrials.gov/ct2/show/NCT03812640). Methods: A total of 80 eyes from 80 patients who underwent pediatric cataract surgery were randomized into two groups in block sizes of four. Group A consisted of 41 patients whose surgical incisions were sutured with polyglactin 10-0 material. Group B consisted of 39 patients whose surgical incisions were sutured with nylon 10-0 material. The primary outcome was frequency of suture-related complications in each group. Secondary outcomes were the frequency with which suture removal was necessary. Results: The incidence of suture-related complications within 6 months of follow up was 0 out of 41 eyes (0.00%) in the polyglactin group and 17 out of 39 eyes (43.59%) in the nylon control group (p < 0.001). In all of the eyes with suture-related complications, the sutures were promptly removed. The most frequent complications were vascularization near the suture (17.95%) and loose sutures (17.95%). No ocular or systemic study-related adverse events were observed. Conclusions: Polyglactin sutures were found to be safe and effective for pediatric patients undergoing cataract surgery. Their lower rate of complications and reduced likelihood of removal (and the subsequent need for general anesthesia) make their use preferrable to that of nylon sutures. This study represents the first controlled randomized clinical trial to compare nylon sutures to polyglactin sutures in pediatric patients undergoing cataract surgery. Clinical Trial Registration: URL: https://clinicaltrials.gov/ct2/show/, Identifier: NCT03812640.

TXNRD2 (rs35934224) CT genotype as possible protective marker for primary open-angle glaucoma in a Brazilian population.

PURPOSE: To investigate the association of the single-nucleotide polymorphism rs35934224 in the TXNRD2 gene with primary open-angle glaucoma in a Brazilian population. METHODS: This was a cross-sectional study conducted to verify the association between the rs35934224 TXNRD2 (thioredoxin reductase 2) and primary open-angle glaucoma in a population from the Northeast region of Brazil. A total of 184 individuals were enrolled, including 94 with primary open-angle glaucoma (45 men and 49 women) and 94 controls (40 men and 54 women) from the Recife Eye Institute. RESULTS: The mean age was 68.85 years for the patients with glaucoma and 68.55 years for the controls. Genomic DNA was isolated using commercially available kits, and single-nucleotide polymorphism was detected with real-time polymerase chain reaction using TaqMan probes. The studied population was in Hardy-Weinberg equilibrium. The CT genotype was associated with protection against primary open-angle glaucoma (p=0.022). CONCLUSION: Our data suggest an association between TXNRD2 gene polymorphism (rs35934224) with primary open-angle glaucoma in an admixed Brazilian po pulation. This is the first study to investigate this single-nucleo tide polymorphism in Latin American individuals with primary open-angle glaucoma.

Optical coherence tomography angiography: microvascular alterations in diabetic eyes without diabetic retinopathy / Angiografia por tomografia de coerência óptica: alterações microvasculares em olhos diabéticos sem retinopatia diabética

ABSTRACT Purpose: To describe microvascular changes in the maculas of individuals with type 2 diabetes observed on optical coherence tomography angiography (OCTA) images. We compared the maculas of diabetic subjects without diabetic retinopathy with those of healthy subjects and correlated the findings with the clinical profiles of diabetic subjects. Methods: One eye each of 30 patients with diabetes and 30 healthy individuals were examined. The patients with diabetes underwent funduscopy, retinography, and fluorescein angiography to rule out retinopathy. All subjects underwent optical coherence tomography angiography of a macular area (6×6 mm2), and the foveal and parafoveal vascular densities were analyzed in the superficial and deep retinal vascular plexus. The foveal and parafoveal thicknesses, foveal avascular zone of the superficial plexus, and choriocapillaris flow area were also examined. The optical coherence tomography angiography results were compared between the two study groups and correlated with the following parameters: visual acuity, time since diabetes diagnosis, glycemic control, lipid profile, and renal function of patients with diabetes. Results: A minimal increase in the choriocapillaris flow area was observed in the patients with diabetes (mean area, 22.3 ± 4.6 mm2 in controls; 22.6 ± 3.9 mm2 in patients with diabetes) (p=0.017). No significant differences were observed between other optical coherence tomography angiography parameters analyzed in the two groups. Glycosylated hemoglobin and fasting blood glucose levels were significantly negatively correlated with the foveal vascular density of both plexuses; conversely, fasting blood glucose levels were positively correlated with the choriocapillaris flow area (p=0.034). The other clinical parameters were not correlated with the optical coherence tomography angiography findings. Conclusion: Optical coherence tomography angiography may not be the most appropriate tool for detecting preclinical changes in patients with diabetes, moreover, optical coherence tomography angiography; does not replace clinical examinations. Glycemic control should be the primary clinical parameter considered during retinopathy screening. Larger studies are necessary to confirm these findings.

RESUMO Objetivo: Descrever alterações microvasculares na mácula em diabéticos do tipo 2 sem retinopatia diabética e pacientes saudáveis, e correlacionar achados com perfil clínico nos diabéticos. Métodos: Foram incluídos 60 olhos de 30 diabéticos e 30 pacientes saudáveis. Diabéticos realizaram fundoscopia, retinografia® (CR2; Canon Inc., New York, New York, USA) e angiografia fluoresceínica® (TRC-50DXC; Topcon Inc., Tokyo, Japan) para descartar a presença de retinopatia. Os 60 pacientes realizaram a angiografia por tomografia de coerência óptica® (RTVue XR, Avanti, Optovue, Fremont, CA, USA) (área macular: 6 x 6 mm2) e foram analisados densidade vascular total, foveal e parafoveal no plexo capilar superficial e plexo capilar profundo, espessura foveal, espessura parafoveal, área da zona avascular da fóvea no plexo capilar superficial e área de fluxo da coriocapilar. Resultados da angiografia por tomografia de coerência óptica foram comparados entre os 2 grupos e correlacionados com acuidade visual, tempo de diabetes, controle glicêmico, perfil lipídico e função renal nos diabéticos. Resultados: Observou-se aumento mínimo da área de fluxo da coriocapilar nos diabéticos, média das áreas foi de 22,3 ± 4,6 mm2 no grupo controle e 22,6 ± 3,9 mm2 em diabéticos (p=0,017). Não foi observada diferença estatisticamente significante entre outras variáveis da angiografia por tomografia de coerência óptica analisadas nos dois grupos. Hemoglobina glicosilada e glicemia de jejum apresentaram correlação negativa estatisticamente significante com densidade vascular foveal de ambos os plexos e a glicemia de jejum se correlacionou positivamente com área de fluxo da coriocapilar (p=0,034). Outros dados clínicos avaliados não apresentaram correlação com achados da angiografia por tomografia de coerência óptica. Conclusão: Resultados sugerem que a angiografia por tomografia de coerência óptica pode não ser a melhor ferramenta na detecção de alterações pré-clínicas em diabéticos, não substituindo o exame clínico, e corroboram a ideia de que o controle glicêmico deve ser o principal parâmetro clínico a ser considerado na triagem da retinopatia. Estudos com amostras maiores são necessários para confirmar os achados.

Role of nicergoline in corneal wound healing in diabetic rats.

BACKGROUND: To investigate the effect of nicergoline on the rate of complete corneal ulcer reepithelialization (CCUR) in diabetic rats with diabetic keratopathy. METHODS: Forty-eight streptozotocin-induced diabetic rats were randomly divided into two groups. The experimental group (n = 24) received nicergoline (10 mg.kg- 1.day- 1), while the control group (n = 24) received a placebo. A corneal epithelial defect was induced using a corneal diamond burr, and defect area was compared at time points of 0, 12, 24, 48 and 72 h after the injury using image analysis software. The probability of CCUR within 72 h was assessed using the Kaplan-Meier survival analysis log-rank test. RESULTS: When compared, 4 of the 24 rats (17%) in the placebo group and 12 of the 24 rats (50%) in the nicergoline group were found to have CCUR within 72 h (log-rank = 0.027). Cox regression analysis found no effect of the covariates blood glucose (P = 0.601) or weight (P = 0.322) on the corneal reepithelialization (survival) curve. CONCLUSIONS: Nicergoline increased wound healing rates relative to placebo and may therefore be investigated as a treatment option in diabetic keratopathy.

Optical coherence tomography angiography: microvascular alterations in diabetic eyes without diabetic retinopathy.

PURPOSE: To describe microvascular changes in the maculas of individuals with type 2 diabetes observed on optical coherence tomography angiography (OCTA) images. We compared the maculas of diabetic subjects without diabetic retinopathy with those of healthy subjects and correlated the findings with the clinical profiles of diabetic subjects. METHODS: One eye each of 30 patients with diabetes and 30 healthy individuals were examined. The patients with diabetes underwent funduscopy, retinography, and fluorescein angiography to rule out retinopathy. All subjects underwent optical coherence tomography angiography of a macular area (6×6 mm2), and the foveal and parafoveal vascular densities were analyzed in the superficial and deep retinal vascular plexus. The foveal and parafoveal thicknesses, foveal avascular zone of the superficial plexus, and choriocapillaris flow area were also examined. The optical coherence tomography angiography results were compared between the two study groups and correlated with the following parameters: visual acuity, time since diabetes diagnosis, glycemic control, lipid profile, and renal function of patients with diabetes. RESULTS: A minimal increase in the choriocapillaris flow area was observed in the patients with diabetes (mean area, 22.3 ± 4.6 mm2 in controls; 22.6 ± 3.9 mm2 in patients with diabetes) (p=0.017). No significant differences were observed between other optical coherence tomography angiography parameters analyzed in the two groups. Glycosylated hemoglobin and fasting blood glucose levels were significantly negatively correlated with the foveal vascular density of both plexuses; conversely, fasting blood glucose levels were positively correlated with the choriocapillaris flow area (p=0.034). The other clinical parameters were not correlated with the optical coherence tomography angiography findings. CONCLUSION: Optical coherence tomography angiography may not be the most appropriate tool for detecting preclinical changes in patients with diabetes, moreover, optical coherence tomography angiography; does not replace clinical examinations. Glycemic control should be the primary clinical parameter considered during retinopathy screening. Larger studies are necessary to confirm these findings.