Preoperative Bevacizumab for Tractional Retinal Detachment in Proliferative Diabetic Retinopathy: A Prospective Randomized Clinical Trial.

PURPOSE: To assess the effectiveness and safety of an intravitreal injection of 1.25 mg bevacizumab (IVB) as a preoperative adjunct to small-gauge pars plana vitrectomy (PPV) compared with PPV alone in eyes with tractional retinal detachment secondary to proliferative diabetic retinopathy. METHODS: This prospective, double-masked, randomized, multicenter, active-controlled clinical trial enrolled 224 eyes of 224 patients between November 2013 and July 2015. All eyes underwent a baseline examination including best-corrected visual acuity, color photos, optical coherence tomography, and fluorescein angiography. Data were collected on intraoperative bleeding, total surgical time, early (<1 month) postoperative vitreous hemorrhage, and mean change in best-corrected visual acuity at 12 months. P < .05 was considered statistically significant. RESULTS: A total of 214 patients (214 eyes) were randomized in a 1:1 ratio to PPV plus IVB ([study group] 102 eyes) or PPV plus sham ([control] 112 eyes). Iatrogenic retinal breaks were noted intraoperatively in 35 eyes (34.3%) in the study group, and 66 eyes (58.9%) in the control group (P = .001). Grade 2 intraoperative bleeding was noted in 32 (31.3%) eyes in the study group and 58 (51.7 %) eyes in the control group (P = .001). Endodiathermy was necessary in 28 (27.4 %) eyes in the study group, compared with 75 (66.9%) eyes in the control group (P = .0001). Mean surgical time was 71.3 ± 32.1 minutes in the study group and 83.6 ± 38.7 minutes in the control group (P = .061). CONCLUSION: Preoperative IVB seems to reduce intraoperative bleeding, improving surgical field visualization, and reducing intraoperative and postoperative complications. NOTE: Publication of this article is sponsored by the American Ophthalmological Society.

Tratamento cirúrgico da retinopatia diabética / Surgical management of diabetic retinopathy

A retinopatia diabética é a causa mais frequente de cegueira na população ativa nos países desenvolvidos. A prevalência da retinopatia diabética aumenta com a duração da diabetes, e praticamente 100% dos pacientes com diabetes tipo I (DM I) e mais do que 60% dos pacientes com o tipo II (DM II) apresentarão algum sinal de retinopatia após 20 anos. Além de um controle sistêmico rigoroso dos níveis glicêmicos, lipídicos, colesterol e da pressão arterial, o exame oftalmológico de rotina, com a identificação precoce da retinopatia diabética, podem detectar anormalidades em estágios primários, o que possibilita o tratamento ainda na fase inicial do problema; o uso adequado da fotocoagulação e a utilização da terapia antiangiogênica pode reduzir o número de pacientes com hemorragia vítrea ou descolamento tracional da retina. Infelizmente, em vários pacientes, a retinopatia progride mesmo com as melhores condutas tomadas pelo paciente e pelo oftalmologista, embora vários olhos podem se beneficiar com o tratamento cirúrgico, a vitrectomia posterior via pars plana. Esta revisão apresenta as indicações atuais para cirurgia vitreorretiniana em pacientes portadores de retinopatia diabética proliferativa...

Diabetic retinopathy is the leading cause of blindness among the working population in the developed world. The prevalence of diabetic retinopathy increases with duration of diabetes, and nearly 100 percent of patients with type I diabetes and more than 60 percent of those with type II have some signs of diabetic retinopathy after 20 years.A number of approaches have proved to be useful in the treatment of diabetic retinopathy, such as laser photocoagulation and tight systemic control of blood glucose, lipids, cholesterol and blood pressure. Unfortunately, in many patients the retinopathy progresses in spite of the best efforts on the part of the patient and of the ophthalmologist. Many such eyes may be helped by vitrectomy surgery, however.About 5 percent of patients with proliferative diabetic retinopathy, as well as carefully selected patients with diabetic maculopathy, require pars plana vitrectomy, despite ostensibly adequate laser treatment and good glycemic and hypertensive control. This article reviews the current indications for vitreous surgery in severe diabetic retinopathy and strategies and techniques employed to minimize surgical complications...

Nematode infections of the eye: toxocariasis, onchocerciasis, diffuse unilateral subacute neuroretinitis, and cysticercosis.

Nematode infections of the eye are common in different parts of the world, but some are usually encountered only in developing nations, such as onchocerciasis and cysticercosis. Ocular toxocariasis is a well-known cause of unilateral ocular disease affecting mainly children and young adults, and is usually caused by T canis. Prevention of ocular toxocariasis is based on such measures as appropriate health care for dogs and cats, including regular anthelmintic treatments, preventing contamination of the environment with feces, and promoting responsible pet ownership [1,49-51]. Onchocerciasis is caused by infection with the filarial parasite O volvulus, and occurs in endemic areas along rivers and streams. In hyperendemic areas almost every person is infected and about half of the population is eventually blinded by onchocerciasis. Because of this, elimination of host-vector contact is very important. DUSN is caused by a motile nematode and is found in the Southeastern and Midwestern United States and in many parts of the world. In Brazil, DUSN is becoming an important cause of posterior uveitis in children and young healthy adults. The destruction of the worm during the early stages of the disease can prevent progression of the visual loss. It is important to remain aware of this entity, not only in areas where it has been described, but also in regions not yet identified as being endemic [52]. Cysticercosis is caused by the encystment of the larvae of the tapeworm T solium, and usually results from ingesting eggs from food, water, or other material contaminated with human feces. Surgical removal of the cyst is usually indicated when possible.

Tumores conjuntivais: ocorrência na clínica oftalmológica da Faculdade de Ciências Médicas da Unicamp / Conjunctival tumors: a survey in the ophtlalmologic clinic of the Unicamp during the year of 1995

Os autores analisam 42 casos de tumores conjuntivais e tecem consideraçöes sobre o aspecto clínico e histopatológico. Os carcinomas epidermóides corresponderam a 50 por cento (21/42) dos casos. Processo inflamatório crônico foi o diagnóstico de três casos (7,14 por cento). Disceratose foi o diagnóstico histopatológico de 2 casos (4,76 por cento), carcinoma in situ (2,38 por cento) e metaplasia escamosa epitelial (2,38 por cento) e um caso cada. Os autores discutem detalhes do tratamento dessas lesöes