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2.
Cell Physiol Biochem ; 54(1): 142-159, 2020 Feb 07.
Artigo em Inglês | MEDLINE | ID: mdl-32028545

RESUMO

BACKGROUND/AIMS: It is well established that oxidative stress and inflammation are common pathogenic features of retinal degenerative diseases. ITH12674 is a novel compound that induces the transcription factor Nrf2; in so doing, the molecule exhibits anti-inflammatory, and antioxidant properties, and affords neuroprotection in rat cortical neurons subjected to oxidative stress. We here tested the hypothesis that ITH12674 could slow the retinal degeneration that causes blindness in rd10 mice, a model of retinitis pigmentosa. METHODS: Animals were intraperitoneally treated with 1 or 10 mg/Kg ITH12674 or placebo from P16 to P30. At P30, retinal functionality and visual acuity were analyzed by electroretinography and optomotor test. By immunohistochemistry we quantified the photoreceptor rows and analyzed their morphology and connectivity. Oxidative stress and inflammatory state was studied by Western blot, and microglia reactivity was monitored by flow cytometry. The blood-brain barrier permeation of ITH12674 was evaluated using a PAMPA-BBB assay. RESULTS: In rd10 mice treated with 10 mg/Kg of the compound, the following changes were observed (with respect to placebo): (i) a decrease of vision loss with higher scotopic a- and b-waves; (ii) increased visual acuity; (iii) preservation of cone photoreceptors morphology, as well as their synaptic connectivity; (iv) reduced expression of TNF-α and NF-κB; (v) increased expression of p38 MAPK and Atg12-Atg5 complex; and (vi) decreased CD11c, MHC class II and CD169 positive cell populations. CONCLUSION: These data support the view that a Nrf2 inducer compound may arise as a new therapeutic strategy to combat retinal neurodegeneration. At present, we are chemically optimising compound ITH12674 with the focus on improving its neuroprotective potential in retinal neurodegenerative diseases.


Assuntos
Isotiocianatos/uso terapêutico , Melatonina/análogos & derivados , Fator 2 Relacionado a NF-E2/agonistas , Retinite Pigmentosa/tratamento farmacológico , Animais , Barreira Hematoencefálica/efeitos dos fármacos , Barreira Hematoencefálica/metabolismo , Modelos Animais de Doenças , Eletrorretinografia , Feminino , Regulação da Expressão Gênica/efeitos dos fármacos , Isotiocianatos/química , Isotiocianatos/farmacologia , Masculino , Melatonina/química , Melatonina/farmacologia , Melatonina/uso terapêutico , Camundongos , Camundongos Endogâmicos C57BL , Fator 2 Relacionado a NF-E2/metabolismo , Células Fotorreceptoras/efeitos dos fármacos , Células Fotorreceptoras/patologia , Retina/efeitos dos fármacos , Retina/metabolismo , Retinite Pigmentosa/metabolismo , Retinite Pigmentosa/patologia , Fator de Necrose Tumoral alfa/metabolismo , Acuidade Visual/efeitos dos fármacos , Proteínas Quinases p38 Ativadas por Mitógeno/metabolismo
3.
Medicine (Baltimore) ; 99(7): e19102, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32049817

RESUMO

BACKGROUND: Traditional Chinese medicine (TCM) has been used to treat diabetic complications including diabetic retinopathy for many years. OBJECTIVES: This review was performed to systematically assess the efficacy and safety of TCM for treating non- proliferative diabetic retinopathy (NPDR). METHODS: Retrieval from 7 electronic databases was conducted to determine eligible trials published until March 1, 2018. Randomized controlled trials of NPDR that comparing compound Chinese medicine containing the therapeutic method of activating blood and remove stasis versus controls were included for analysis. Primary outcomes were progression of retinopathy. Secondary outcomes included visual acuity, mean defect of visual field, micro-aneurysms, hemorrhage areas, exudates, capillary nonperfusion areas, hemorheological indicators, oscillatory potentials (Ops), glycated haemoglobin (HbA1c), and adverse events. Data extraction and quality assessment were performed. Results expressing as risk ratios (RRs) or mean differences (MD) were analyzed with a fixed- or random- effect model. I statistics were used to assess heterogeneity. RESULTS: A total of 33 trials and 3373 participants were included. Findings revealed that no included studies reported the progression of retinopathy. Compared with conventional medicine, TCM was significantly better at improving visual acuity (MD, -0.10; 95% confidence interval [CI] -0.16 to -0.05) and Ops (MD, -4.68, 95% CI -8.51 to -0.85), and reducing the mean defect of visual field (MD, -1.43; 95%CI, -2.17 to -0.68), micro-aneurysms (MD, -4.51; 95% CI, -6.23 to -2.79), hemorrhage areas (MD, -0.62; 95% CI, -1.06 to -0.19), plasma viscosity (MD, -0.10; 95% CI, -0.20 to 0.00), and HbA1c (MD, -0.22; 95% CI, -0.42 to -0.03). Compared with placebo, TCM was also associated with a decline in the number of microaneurysms (MD, -4.35; 95% CI, -6.25 to -2.45), exudates (MD, -0.17; 95% CI -0.31 to -0.03), capillary nonperfusion areas (MD, -0.18; 95% CI, -0.31 to -0.04), and HbA1c (MD, -0.88; 95% CI, -1.44 to -0.32). Compared with blank groups, TCM was superior at decreasing the mean defect of visual field (MD, -0.87; 95% CI -0.95 to -0.79) and the numbers of micro-aneurysms (MD, -3.35; 95% CI, -4.73 to -1.97). Adverse events were also assessed. CONCLUSION: Activating blood compound Chinese herbal medicine could help to improve visual acuity, micro-aneurysms and HbA1c. Further trials are needed to provide more reliable evidence.


Assuntos
Retinopatia Diabética/tratamento farmacológico , Medicina Tradicional Chinesa/métodos , Adulto , Idoso , Retinopatia Diabética/sangue , Progressão da Doença , Feminino , Humanos , Masculino , Medicina Tradicional Chinesa/efeitos adversos , Pessoa de Meia-Idade , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento , Acuidade Visual/efeitos dos fármacos
4.
Lancet ; 395(10220): 294-303, 2020 01 25.
Artigo em Inglês | MEDLINE | ID: mdl-31982075

RESUMO

BACKGROUND: In chronic central serous chorioretinopathy (CSCR), fluid accumulates in the subretinal space. CSCR is a common visually disabling condition that develops in individuals up to 60 years of age, and there is no definitive treatment. Previous research suggests the mineralocorticoid receptor antagonist, eplerenone, is effective for treating CSCR; however, this drug is not licensed for the treatment of patients with CSCR. We aimed to evaluate whether eplerenone was superior to placebo in terms of improving visual acuity in patients with chronic CSCR. METHODS: This randomised, double-blind, parallel-group, multicentre placebo-controlled trial was done at 22 hospitals in the UK. Participants were eligible if they were aged 18-60 years and had had treatment-naive CSCR for 4 months or more. Patients were randomly assigned (1:1) to either the eplerenone or the placebo group by a trial statistician through a password-protected system online. Allocation was stratified by best-corrected visual acuity (BCVA) and hospital. Patients were given either oral eplerenone (25 mg/day for 1 week, increasing to 50 mg/day for up to 12 months) plus usual care or placebo plus usual care for up to 12 months. All participants, care teams, outcome assessors, pharmacists, and members of the trial management group were masked to the treatment allocation. The primary outcome was BCVA, measured as letters read, at 12 months. All outcomes apart from safety were analysed on a modified intention-to-treat basis (participants who withdrew consent without contributing a post-randomisation BCVA measurement were excluded from the primary analysis population and from most secondary analysis populations). The trial is registered with ISRCTN, ISRCTN92746680, and is completed. FINDINGS: Between Jan 11, 2017, and Feb 22, 2018, we enrolled and randomly assigned 114 patients to receive either eplerenone (n=57) or placebo (n=57). Three participants in the placebo group withdrew consent without contributing a post-randomisation BCVA measurement and were excluded from the primary outcome analysis population. All patients from the eplerenone group and 54 patients from the placebo group were included in the primary outcome. Modelled mean BCVA at 12 months was 79·5 letters (SD 4·5) in the placebo group and 80·4 letters (4·6) in the eplerenone group, with an adjusted estimated mean difference of 1·73 letters (95% CI -1·12 to 4·57; p=0·24) at 12 months. Hyperkalaemia occurred in eight (14%) patients in each group. No serious adverse events were reported in the eplerenone group and three unrelated serious adverse events were reported in the placebo group (myocardial infarction [anticipated], diverticulitis [unanticipated], and metabolic surgery [unanticipated]). INTERPRETATION: Eplerenone was not superior to placebo for improving BCVA in people with chronic CSCR after 12 months of treatment. Ophthalmologists who currently prescribe eplerenone for CSCR should discontinue this practice. FUNDING: Efficacy and Mechanism Evaluation Programme, and National Institute for Health Research and Social Care.


Assuntos
Coriorretinopatia Serosa Central/tratamento farmacológico , Eplerenona/uso terapêutico , Antagonistas de Receptores de Mineralocorticoides/uso terapêutico , Adulto , Coriorretinopatia Serosa Central/fisiopatologia , Doença Crônica , Método Duplo-Cego , Eplerenona/efeitos adversos , Feminino , Seguimentos , Humanos , Masculino , Adesão à Medicação/estatística & dados numéricos , Pessoa de Meia-Idade , Antagonistas de Receptores de Mineralocorticoides/efeitos adversos , Resultado do Tratamento , Acuidade Visual/efeitos dos fármacos , Adulto Jovem
5.
Medicine (Baltimore) ; 98(51): e18333, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31860985

RESUMO

To determine characteristics of diabetic macular edema patients with serous retinal detachment (SRD).We classified naïve diabetic macular edema (DME) patients with or without SRD, and compared their baseline characteristics; intravitreal bevacizumab (IVB) responsiveness; aqueous concentrations of IL (interleukin)-1ß, -2, -8, -10, -17, placental growth factor (PlGF), and vascular endothelial growth factor (VEGF). In addition, factors associated with the existence of SRD were identified.Of the 64 DME patients, 14 had SRD. The average levels of aqueous VEGF and PlGF were significantly higher in the SRD group than in the control group (P = .022 and P = .041, respectively). The best-corrected visual acuity (BCVA) and central subfield thickness (CST) did not differ significantly between the 2 groups at baseline or after 3 consecutive monthly IVBs. In multivariate logistic regression analysis, the level of aqueous VEGF was the only factor associated with the existence of SRD (odds ratio: 1.03; P = .038).Rather than aqueous inflammatory cytokines, levels of aqueous VEGFs were associated with the occurrence of SRD in DME patients. In terms of prognosis, the existence of SRD was not related with BCVA or CST changes.


Assuntos
Humor Aquoso/metabolismo , Bevacizumab/uso terapêutico , Retinopatia Diabética/tratamento farmacológico , Edema Macular/tratamento farmacológico , Descolamento Retiniano/tratamento farmacológico , Inibidores da Angiogênese/uso terapêutico , Estudos de Casos e Controles , Retinopatia Diabética/metabolismo , Feminino , Humanos , Interleucina-1beta/metabolismo , Injeções Intravítreas , Edema Macular/metabolismo , Masculino , Pessoa de Meia-Idade , Fator de Crescimento Placentário/metabolismo , Prognóstico , Retina/patologia , Descolamento Retiniano/metabolismo , Fator A de Crescimento do Endotélio Vascular/metabolismo , Acuidade Visual/efeitos dos fármacos
6.
Invest Ophthalmol Vis Sci ; 60(13): 4397-4407, 2019 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-31639826

RESUMO

Purpose: Retinitis pigmentosa (RP), a retinal photoreceptor degeneration, typically affects rod function and subsequently cones. Activation of sigma 1 receptor (Sig1R) has been shown to preserve cone function through 6 weeks in the rd10 mouse model of RP, when mice were treated systemically with the Sig1R ligand (+)-pentazocine (PTZ). This study determined the extent to which cone function is preserved in rd10 mice when Sig1R is activated. Methods: Rd10 mice were administered (+)-PTZ (alternate days beginning at postnatal day [P]14) over a period of 180 days. Mouse visual function and structure were measured in vivo using optokinetic tracking response, scotopic and photopic electroretinography plus photopic assessment using "natural" noise stimuli, and optical coherence tomography (OCT). Immunofluorescent methods were used to detect cones in retinal cryosections. Results: Visual acuity was maintained in rd10(+)-PTZ-treated mice through P56, whereas rd10 nontreated mice showed marked decline by P28. Cone responses were detected in (+)-PTZ-treated mice through P60, which were more robust when tested with natural noise stimuli; cone responses were minimal in nontreated rd10 mice. OCT revealed significantly thicker retinas in (+)-PTZ-treated rd10 mice through P60 compared to nontreated mice. Cones were detected by immunofluorescence in (+)-PTZ-treated rd10 retinas through P120. Conclusions: The extent to which cone rescue could be sustained in (+)-PTZ-treated rd10 mice was evaluated comprehensively, showing that activation of Sig1R is associated with prolonged visual acuity, extended detection of cone function, and detection of cones in retinal histologic sections. The data reflect promising long-term neuroprotection when Sig1R is activated.


Assuntos
Analgésicos Opioides/uso terapêutico , Modelos Animais de Doenças , Pentazocina/uso terapêutico , Receptores sigma/metabolismo , Células Fotorreceptoras Retinianas Cones/fisiologia , Retinite Pigmentosa/tratamento farmacológico , Acuidade Visual/efeitos dos fármacos , Animais , Sobrevivência Celular/fisiologia , Visão de Cores/fisiologia , Eletrorretinografia , Pressão Intraocular , Camundongos , Camundongos Endogâmicos C57BL , Camundongos Knockout , Visão Noturna/fisiologia , Nistagmo Optocinético/fisiologia , Retina/metabolismo , Retina/fisiopatologia , Retinite Pigmentosa/metabolismo , Retinite Pigmentosa/fisiopatologia , Tomografia de Coerência Óptica , Acuidade Visual/fisiologia
7.
Exp Eye Res ; 188: 107805, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31526807

RESUMO

Macular edema (ME), which is present in various retinal diseases, leads to permanent retinal structural damage and threatens vision. The intravitreal/periocular injection of triamcinolone acetonide (TA) can improve the prognosis of ME; however, further exploration of noninvasive delivery systems is essential. Therefore, as a continuation of our previous study using TA-chitosan coated liposomes (TA-CHLs) as a topical drug delivery system, the present study aimed to determine the drug safety, stability, permeability, and bioavailability of TA-CHLs. The study was based on detecting the delivery of a fluorescent dye to the retina using optical coherence tomography angiography in rats. Marked cellular uptake was observed in cell lines. TA-CHL toxicity was investigated in cell culture. Clinical ocular safety was evaluated by measuring the corneal thickness and intraocular pressure. In preclinical studies on a laser-induced retinal edema rat model, the TA-CHL eye drops had dramatic therapeutic effect in remission of retinal edema over 10 days. These results demonstrated that TA-CHL was nontoxic and had good bioavailability in vitro and in vivo. The results of the present study indicated that this formulation could be an effective therapeutic approach and the TA-CHL eye drops may represent a new option for retinal diseases.


Assuntos
Quitosana/uso terapêutico , Materiais Revestidos Biocompatíveis , Glucocorticoides/uso terapêutico , Lipossomos , Papiledema/tratamento farmacológico , Triancinolona Acetonida/uso terapêutico , Administração Oftálmica , Animais , Disponibilidade Biológica , Barreira Hematorretiniana/efeitos dos fármacos , Quitosana/farmacocinética , Quitosana/toxicidade , Modelos Animais de Doenças , Sistemas de Liberação de Medicamentos , Feminino , Corantes Fluorescentes/metabolismo , Glucocorticoides/farmacocinética , Glucocorticoides/toxicidade , Pressão Intraocular/efeitos dos fármacos , Injeções Intravítreas , Soluções Oftálmicas , Papiledema/fisiopatologia , Ratos , Ratos Endogâmicos BN , Tomografia de Coerência Óptica , Triancinolona Acetonida/farmacocinética , Triancinolona Acetonida/toxicidade , Acuidade Visual/efeitos dos fármacos
8.
Acta Diabetol ; 56(12): 1341-1350, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31541334

RESUMO

AIMS: To provide 2-year follow-up data on eyes with diabetic macular edema (DME) that were non-responsive after three initial anti-vascular endothelial growth factor (VEGF) injections, comparing functional and anatomical outcomes under continued anti-VEGF therapy versus dexamethasone (DEX) implant. METHODS: Multicenter, retrospective chart review comparing eyes with treatment-naïve DME and a suboptimal response to a loading phase of anti-VEGF therapy (3 injections given monthly) which were then treated with (a) further anti-VEGF (n = 72) or (b) initially switched to DEX implant (n = 38). Main outcome measures were change in visual acuity (VA) and central subfield thickness (CST) from the end of the loading phase to 24 months. RESULTS: In 79% of the 12-month study population (87/110 eyes), 24-month data were available. One quarter of eyes in each group switched treatments during the second year. Eyes that were switched early to DEX implant maintained the functional and anatomical improvements at 24 months which were seen in the first year (from month 3: + 8.9 letters, - 214 µm). Eyes that were switched from anti-VEGF therapy to steroids in the second year improved VA and reduced CST at 24 months (from month 12: + 6.8 letters, p = 0.023; - 226 µm, p = 0.004). In eyes continued on anti-VEGF therapy, VA and CST were stable at 24 months (from month 3: + 2.8 letters, p = 0.254; - 24 µm, p = 0.243). Eyes that were non-responsive to anti-VEGF therapy for 12 months had similar chances to experience a VA gain from further therapy as eyes that were non-responsive for 3 months only (23.8 vs. 31.0%, p = 0.344). CONCLUSIONS: The beneficial effect of an early switch to DEX implant in DME non-responders seen at month 12 was maintained during the second year. A later switch from anti-VEGF to steroids still provided significant improvement. Eyes continued on anti-VEGF over a period of 24 months maintained vision. A quarter of eyes, which had not improved vision at 12 months, exhibited a delayed response to treatment.


Assuntos
Inibidores da Angiogênese/administração & dosagem , Dexametasona/administração & dosagem , Retinopatia Diabética/tratamento farmacológico , Edema Macular/tratamento farmacológico , Fator A de Crescimento do Endotélio Vascular/antagonistas & inibidores , Idoso , Bevacizumab/administração & dosagem , Retinopatia Diabética/epidemiologia , Esquema de Medicação , Implantes de Medicamento , Resistência a Medicamentos/efeitos dos fármacos , Substituição de Medicamentos , Feminino , Humanos , Injeções Intravítreas , Edema Macular/epidemiologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Fator A de Crescimento do Endotélio Vascular/imunologia , Acuidade Visual/efeitos dos fármacos
9.
Indian J Pharmacol ; 51(3): 157-167, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31391683

RESUMO

INTRODUCTION: Riboflavin- and ultraviolet (UV)-A-mediated collagen cross-linking of the cornea is a frequently used therapeutic measure for the treatment of progressive keratoconus (PK). First, riboflavin increases cross-linking and second, it serves as a protective shield to other deep ocular structures. However, pharmacogenomic variation in riboflavin efficacy is reported. As the Northeast Indian population represents a genetically diverse group of population compared to mainstream India, we have assessed the efficacy of the procedure in a northeastern population with PK. METHODS: In this study, 78 eyes with PK were included (n = 39 in the treatment arm and n = 39 in the control arm). The primary objective was to evaluate the effect of corneal collagen cross-linking using riboflavin (C3R) (epithelium off) on maximum keratometry. The secondary objectives were evaluation of change in corneal topography parameters, i.e., minimum keratometry (Kmin), simulated keratometry (Sim K), subjective refraction (cylinder power, spherical power, and spherical equivalent [SE]), uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), and contrast sensitivity (CS) and safety (intraocular pressure, endothelial cell density, and percentage hexagonality) at 1, 3, and 6 months following C3R procedure. RESULTS: Statistically significant improvement was noted in Kmin (6 months), Sim K (3 and 6 months), cylinder power (3 and 6 months), spherical power (3 and 6 months), SE (3 and 6 months), BCVA (6 months), and UCVA (1, 6 months) in the C3R group (n = 39) when compared to the control group (n = 39). The mean CS decreased at 1 month and gradually improved to achieve statistically significant value at 6 months in the C3R group (P < 0.05). CONCLUSION: Riboflavin-assisted C3R treatment showed promising efficacy in the treatment of PK patients in our population. As the collagen turnover rate of cornea is 2-3 years and the progression of PK is highly variable, we need long-term studies to evaluate the efficacy of C3R over time, requirement of repeat therapy, and safety of repeat cross-linking.


Assuntos
Colágeno/metabolismo , Córnea/efeitos dos fármacos , Reagentes para Ligações Cruzadas/uso terapêutico , Ceratocone/tratamento farmacológico , Fármacos Fotossensibilizantes/uso terapêutico , Riboflavina/uso terapêutico , Raios Ultravioleta , Adolescente , Adulto , Córnea/metabolismo , Topografia da Córnea , Feminino , Humanos , Ceratocone/metabolismo , Masculino , Resultado do Tratamento , Acuidade Visual/efeitos dos fármacos , Adulto Jovem
10.
Medicine (Baltimore) ; 98(35): e16886, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31464918

RESUMO

RATIONALE: Posterior scleritis is an ocular inflammatory disorder that can be associated with both infectious and non-infectious immune reactions. Behcet disease is a chronic, relapsing, multisystemic inflammatory disorder with uveitis. There are no reported cases of posterior scleritis with Bechet disease. PATIENT CONCERNS: A 50-year-old man previously diagnosed with systemic Behcet disease presented with ocular pain and decreased vision in the left eye. DIAGNOSIS: Posterior scleritis associated with Behcet disease was diagnosed based on optical coherence tomography showing choroidal folds, as well as contrast computed tomography and ultrasound sonography demonstrating thickening of the posterior sclera. INTERVENTIONS: Treatment with systemic corticosteroids was initiated. Since inflammation relapsed during steroid tapering, anti-tumor necrosis factor-alpha (TNF-α) therapy was used in combination, and tapering of steroids was possible without recurrence of inflammation for 12 months. OUTCOMES: Posterior scleritis was resolved and visual acuity improved. With the continuation of TNF-α therapy, oral prednisolone was successfully tapered and discontinued. No relapse of inflammation was observed at follow-up 1 year after discontinuation of prednisolone. LESSONS: Ophthalmologists should be aware of the possibility of rare manifestation of posterior scleritis in patients with Behcet disease, and that combined use of systemic steroids and anti-TNF-α therapy may resolve the scleritis without recurrence of inflammation.


Assuntos
Corticosteroides/uso terapêutico , Síndrome de Behçet/complicações , Esclerite/diagnóstico por imagem , Fator de Necrose Tumoral alfa/uso terapêutico , Corticosteroides/farmacologia , Humanos , Masculino , Pessoa de Meia-Idade , Esclerite/tratamento farmacológico , Esclerite/etiologia , Tomografia de Coerência Óptica , Resultado do Tratamento , Fator de Necrose Tumoral alfa/farmacologia , Ultrassonografia , Acuidade Visual/efeitos dos fármacos
11.
Chin Med J (Engl) ; 132(17): 2073-2078, 2019 Sep 05.
Artigo em Inglês | MEDLINE | ID: mdl-31261204

RESUMO

BACKGROUND: Rapid visual acuity (VA) decline was a common complaint in patients with sellar/suprasellar germinoma. In our hospital, 3.4 Gy/2f of emergency irradiation was applied to save patient VA and enable subsequent chemoradiotherapy. This study aimed to investigate the efficacy of emergency irradiation with 3.4 Gy/2f in patients with sellar/suprasellar germinoma who had rapid VA decline. METHODS: From January 2014 to December 2017, 33 patients with sellar/suprasellar germinoma who complained of VA decline within 3 months received 3.4 Gy/2f of emergency irradiation in Beijing Tiantan Hospital. The best-corrected VA (BCVA) and mean deviation (MD) were measured. Correlations between visual function change and clinical factors, including age at diagnosis, duration of VA decline, extent of tumor regression, serum level of tumor markers, were analyzed. RESULTS: Among 33 patients with sellar/suprasellar germinoma, the median diameter and volume of sellar/suprasellar lesions were 32 mm (range: 5-55 mm) and 12.9 cm (range 0.6-58.5 cm), respectively. Data on pre- and post-emergency-irradiation BCVA were obtained in 32 patients. For the right eyes, BCVA was improved in 23 patients (71.9%), unchanged in 7 (21.9%), and worsened in 2 (6.2%); and for the left eyes, these numbers were 27 (84.4%), 4 (12.5%), and 1 (3.1%), respectively. In terms of the logarithm of the minimum angle of resolution (logarithm of the minimum angle of resolution = Log (1/BCVA) score, the improvement was significant in both eyes (P < 0.001). In terms of MD, six patients had paired data and the improvement was marginal in the right eyes (P = 0.068) and significant in the left eyes (P = 0.043). However, no clinical factor was found to have correlation with visual function improvement. CONCLUSION: In sellar/suprasellar germinoma patients with VA decline, 3.4 Gy/2f of emergency irradiation was effective in improving visual function.


Assuntos
Germinoma/tratamento farmacológico , Germinoma/terapia , Adolescente , Adulto , Criança , Pré-Escolar , Gonadotropina Coriônica/metabolismo , Tratamento Farmacológico , Humanos , Radioterapia , Estudos Retrospectivos , Acuidade Visual/efeitos dos fármacos , Acuidade Visual/fisiologia , Acuidade Visual/efeitos da radiação , Adulto Jovem
12.
BMC Res Notes ; 12(1): 404, 2019 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-31307549

RESUMO

OBJECTIVE: Pakistan is the fifth highest TB burden country. Tuberculous uveitis (TbU) is a form of extrapulmonary TB, that is not uncommon in high burden country but very limited data is available on its outcome. The aim of the study is to assess the outcome of TbU with anti-tuberculous treatment (ATT). RESULTS: A prospective study was conducted at Jinnah Medical College Hospital (JMCH) Karachi, Pakistan from July to December 2017. Patients with suspected TbU were started on standard ATT chemotherapy for 12 months. Their response was assessed via slit lamp examination and visual acuity at 1, 3, 6 and 12 months of treatment. Forty patients with probable TbU were treated with ATT, mean age was 36 ± 3 years and 24 (60%) were females. Around 26 (65%) had Monteux test of 15 mm or more. History of TB contact was positive in 24 (60%) and 12 (30%) had previous history of TB. All patients complained for blurring of vision and floaters. Posterior uveitis seen in 36 (90%) of patients. Complete response achieved in 32 (80%) after ATT while 6 (14%) had changed in inflammation and 2 (6%) had no benefit.


Assuntos
Antituberculosos/uso terapêutico , Encaminhamento e Consulta , Tuberculose Ocular/tratamento farmacológico , Uveíte Posterior/tratamento farmacológico , Acuidade Visual/efeitos dos fármacos , Adulto , Feminino , Seguimentos , Hospitais Universitários , Humanos , Masculino , Paquistão , Estudos Prospectivos , Resultado do Tratamento
13.
Medicine (Baltimore) ; 98(29): e15404, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31335666

RESUMO

This study retrospectively evaluated the effect of lutein supplement (LS) on patients with non-proliferative diabetic retinopathy (NPDR).A total of 72 patients with NPDR were included in this study. All patients received Zeaxanthin during the study period. In addition, 36 patients also received LS and were assigned to the treatment group, while the other 36 patients did not receive LS and were assigned to the control group. All patients were treated for a total of 4 months. The endpoints included visual acuity (VA), contrast sensitivity (CS), and glare sensitivity (GS). In addition, any adverse events were also assessed. All endpoints were measured before and after 4-month treatment.Before treatment, there were no significant differences in VA (P = .75), CS (P = .71), and GS (P = .73) between two groups. After 4-month treatment, there were still no significant differences in all endpoints of VA (P = .66), CS (P = .58), and GS (P = .61) between two groups. No adverse events were recorded in either group.The results of this retrospective study showed that LS may not benefit for patients with NPDR after 4-month treatment. More high quality randomized controlled trials should still be needed to warrant the results of this study.


Assuntos
Diabetes Mellitus Tipo 2/complicações , Retinopatia Diabética/tratamento farmacológico , Retinopatia Diabética/metabolismo , Luteína , Antioxidantes/administração & dosagem , Antioxidantes/efeitos adversos , Sensibilidades de Contraste , Retinopatia Diabética/diagnóstico , Retinopatia Diabética/fisiopatologia , Suplementos Nutricionais , Monitoramento de Medicamentos/métodos , Feminino , Humanos , Luteína/administração & dosagem , Luteína/efeitos adversos , Masculino , Pessoa de Meia-Idade , Estresse Oxidativo/efeitos dos fármacos , Estudos Retrospectivos , Resultado do Tratamento , Acuidade Visual/efeitos dos fármacos
14.
J Fr Ophtalmol ; 42(8): 880-893, 2019 Oct.
Artigo em Francês | MEDLINE | ID: mdl-31204088

RESUMO

PURPOSE: To demonstrate a decrease in distance visual acuity (VA) following instillation of mydriatic eyedrops in eyes with exudative age-related macular degeneration (AMD). MATERIALS AND METHODS: A prospective assessment in clinical practice was conducted in our ophthalmology department at the University Hospital of Tours from 7/19/2018 to 8/29/2018. Distance (ETDRS) and near (Parinaud) VA were assessed before and after instilling one drop each of tropicamide 0.5% and phenylephrine 10% in the 40 included eyes with exudative AMD. RESULTS: The mean difference in distance VA before and after pupillary dilation (PD) was 0.06 LogMAR (SD=0.14) (P<0.01), i.e. -3.05 letters read (SD=7.52) on the ETDRS chart (P=0.01). For near VA, the mean difference was 0.16 LogMAR (SD=0.16) (P<0.001), i.e. -1.58 paragraphs read (SD=1.63) on the Parinaud chart (P<0.001). DISCUSSION: The absence of a clinically significant loss in post-dilation distance VA for exudative AMD could be explained by negligible glare coming from the ETDRS chart, milder photophobia, low pre-dilation VA's and a balance between higher order optical aberrations and diffraction. The opposite result for near VA could essentially be explained by greater glare induced by the light illuminating the Parinaud chart. CONCLUSION: Our primary goal was not achieved. A study presuming the absence of a clinically significant decrease in post-dilation distance VA would be necessary to consider directly measuring post-dilation VA in eyes with exudative AMD in our daily practice.


Assuntos
Percepção de Distância/efeitos dos fármacos , Degeneração Macular/fisiopatologia , Midriáticos/administração & dosagem , Acuidade Visual/efeitos dos fármacos , Degeneração Macular Exsudativa/fisiopatologia , Acomodação Ocular/efeitos dos fármacos , Acomodação Ocular/fisiologia , Idoso , Idoso de 80 Anos ou mais , Percepção de Distância/fisiologia , Feminino , Humanos , Masculino , Midriáticos/efeitos adversos , Soluções Oftálmicas/administração & dosagem , Soluções Oftálmicas/efeitos adversos , Padrões de Prática Médica , Acuidade Visual/fisiologia
15.
BMC Ophthalmol ; 19(1): 124, 2019 Jun 07.
Artigo em Inglês | MEDLINE | ID: mdl-31174513

RESUMO

BACKGROUND: To analyze the clinical features and prognosis of the visual loss resulted from inhalational methanol poisoning in 8 Chinese patients. METHODS: Eight consecutive patients seen at the Beijing Tongren Hospital of Capital Medical University, Beijing, China between January 2003 to August 2017, with complains of vision loss in both eyes, identified as inhalational methanol poisoning. Detailed medical history was extracted. All patients underwent optic nerve and brain magnetic resonance imaging (MRI) scan, laboratory tests, and visual function analysis. Treatment protocols were large dosage of methylprednisolone and B vitamins over 3 months. Patients were seen at 3-month intervals until a year. RESULTS: Eight patients with optic neuropathy caused by inhalation toxicity of methanol were under observation, whose methanol-contact time spans were form 4 days to 5 years for occupational exposure. All the patients had acute onset, transient systemic symptoms on early stage, both eyes involved with severe visual impairment (visual acuity 0.1 or even worse). Retrobulbar optic nerves (ONs) were the major sites involved. Optic nerve MRI scan showed increased signal of bilateral ONs in the orbit and the canal parts, with enhancement. After treatment, the visual function of these patients got improved in different degree in a year follow-up, but not satisfactorily. CONCLUSIONS: Inhalational methanol toxicity may lead to serious damage to ON in a process of chronic intoxication with acute attack, and with poor prognosis.


Assuntos
Metanol/envenenamento , Nervo Óptico/efeitos dos fármacos , Transtornos da Visão/induzido quimicamente , Acuidade Visual/fisiologia , Doença Aguda , Administração por Inalação , Adulto , Encéfalo/diagnóstico por imagem , Doença Crônica , Feminino , Seguimentos , Humanos , Imagem por Ressonância Magnética , Masculino , Metanol/administração & dosagem , Pessoa de Meia-Idade , Nervo Óptico/patologia , Estudos Retrospectivos , Índice de Gravidade de Doença , Solventes/envenenamento , Transtornos da Visão/diagnóstico , Transtornos da Visão/fisiopatologia , Acuidade Visual/efeitos dos fármacos , Adulto Jovem
16.
BMJ Case Rep ; 12(6)2019 Jun 22.
Artigo em Inglês | MEDLINE | ID: mdl-31229985

RESUMO

Kodamaea ohmeri keratitis is an opportunistic pathogen seen in patients who have undergone invasive procedures and immunocompromised state. It has been identified in septicemia patients, resulting in mortality. To the best of our knowledge, we identified the first case of K. ohmeri keratitis following an injury with vegetative material. A 57-year-old woman with underlying, poorly controlled diabetes mellitus was gardening when a tree leaf accidentally poked her in the eye. Two weeks later, the patient presented with right eye pain, redness and progressive blurring of vision due to a traumatised right cornea. Slit-lamp examination showed a small inferior paracentral corneal stromal infiltrate with overlying epithelial defect. A corneal scraping sample yielded K. ohmeri from Analytical Profile Index (API) 20C yeast identification system. She was treated with intensive topical amphotericin B and fluconazole. After 6 weeks of treatment, the keratitis resolved with faint scar tissue, and her visual acuity improved.


Assuntos
Córnea/microbiologia , Infecções Oculares Fúngicas/tratamento farmacológico , Ceratite/microbiologia , Administração Tópica , Anfotericina B/administração & dosagem , Anfotericina B/uso terapêutico , Antifúngicos/administração & dosagem , Antifúngicos/uso terapêutico , Córnea/patologia , Lesões da Córnea/complicações , Substância Própria/patologia , Feminino , Fluconazol/administração & dosagem , Fluconazol/uso terapêutico , Humanos , Hospedeiro Imunocomprometido , Ceratite/patologia , Pessoa de Meia-Idade , Pichia/isolamento & purificação , Folhas de Planta/efeitos adversos , Folhas de Planta/microbiologia , Resultado do Tratamento , Acuidade Visual/efeitos dos fármacos
18.
Middle East Afr J Ophthalmol ; 26(1): 40-42, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31114124

RESUMO

Calotropis procera (ushaar) produces a copious amount of latex, which has both inflammatory and anti-inflammatory pharmacological properties. Local application produces an intense inflammatory response and causes significant ocular morbidity. We report corneal toxicity following self-application of latex from C. procera in a 74-year-old man. He reported painless decreased vision in the affected eye with diffuse corneal edema, and specular microscopy revealed a reduced endothelial cell count. After he was treated with topical corticosteroids, his visual acuity improved from hand motion to 20/80. The composition of the active compounds in the latex was analyzed. When topically administered, the latex may cause severe ocular injuries and a loss of endothelial cells over a period of time. Public education, early recognition of such injuries, and timely intervention may prevent permanent ocular damage.


Assuntos
Calotropis/química , Edema da Córnea/induzido quimicamente , Látex/toxicidade , Transtornos da Visão/induzido quimicamente , Administração Oftálmica , Idoso , Córnea/efeitos dos fármacos , Edema da Córnea/diagnóstico , Edema da Córnea/tratamento farmacológico , Glucocorticoides/uso terapêutico , Humanos , Masculino , Soluções Oftálmicas , Compostos Fitoquímicos , Prednisolona/análogos & derivados , Prednisolona/uso terapêutico , Autoadministração , Transtornos da Visão/diagnóstico , Transtornos da Visão/tratamento farmacológico , Acuidade Visual/efeitos dos fármacos
19.
Chemosphere ; 230: 51-58, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31102871

RESUMO

Pesticide stress is one of the important factors for global bee declines. Apart from physiological and developmental anomalies, pesticides also impose cognitive damages on bees. The present study investigates the visual acuity of wild populations of honey bees, in an agricultural intensification landscape, and corroborates the findings with controlled laboratory experiments. Even though overall morphometric examinations revealed no significant differences between the populations, correct color choices by bees in pesticide exposed populations were significantly reduced. The study reports, for the first time, the significant reduction in ommatidia facet diameter in these populations, as viewed under scanning electron microscope, along with the molecular underpinnings to these findings. Western blot studies revealed a significant reduction in expression of two visual proteins - blue-sensitive opsin and rhodopsin - in the pesticide exposed populations in both field and laboratory conditions. The novel findings from this study form the basis for further investigations into the effects of field realistic doses of multiple pesticide exposures on wild populations of honey bees.


Assuntos
Abelhas/embriologia , Anormalidades do Olho/induzido quimicamente , Anormalidades do Olho/embriologia , Olho/embriologia , Praguicidas/toxicidade , Acuidade Visual/efeitos dos fármacos , Agricultura , Animais , Abelhas/efeitos dos fármacos , Microscopia Eletrônica de Varredura , Opsinas/biossíntese , Rodopsina/biossíntese
20.
Medicine (Baltimore) ; 98(21): e15515, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31124931

RESUMO

PURPOSE: To evaluate the efficacy and safety of orally administered grape seed proanthocyanidin extract (GSPE) in patients with non-proliferative diabetic retinopathy (NPDR). METHODS: In this randomized (1:2:2), multicentre, double-blind trial, patients (n = 124; age: 40-78 years) were administered placebo, calcium dobesilate (CD; 750 mg/d), or GSPE (150 mg/d) orally for up to 12 months. All patients had retinal thickening with hard exudates (HEs) that met predefined criteria; the median best-corrected visual acuity was 0.8, as assessed using the Snellen visual acuity card. The main outcome measure was an improvement in HEs by at least 1 grade on a 10-grade severity scale. This was evaluated using fundus photography over 1 year. RESULTS: The rate of improvement in the HE severity was higher in the GSPE group than in the CD group. No statistically significant difference existed among the study groups in optical coherence tomography parameters, such as central subfield macular thickness and total macular volume (TMV). However, in the GSPE group, TMV after 9 months of treatment was significantly decreased compared with that at baseline. The GSPE group showed a significantly greater improvement in HE severity than did the placebo or CD group. Four cases in the GSPE group and 2 in the CD group were determined to have developed potential treatment-related adverse reactions, which were all gastrointestinal in nature. CONCLUSIONS: Oral GSPE therapy for 1 year improved HEs in patients with NPDR. The efficacy of GSPE for HEs was higher than that of oral CD in the study patients.


Assuntos
Dobesilato de Cálcio/administração & dosagem , Retinopatia Diabética/tratamento farmacológico , Exsudatos e Transudatos/efeitos dos fármacos , Extrato de Sementes de Uva/administração & dosagem , Hemostáticos/administração & dosagem , Proantocianidinas/administração & dosagem , Administração Oral , Idoso , Retinopatia Diabética/patologia , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Índice de Gravidade de Doença , Tomografia de Coerência Óptica , Resultado do Tratamento , Acuidade Visual/efeitos dos fármacos
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