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1.
Cochrane Database Syst Rev ; 9: CD001862, 2020 09 21.
Artigo em Inglês | MEDLINE | ID: mdl-32959365

RESUMO

BACKGROUND: Ophthalmia neonatorum is an infection of the eyes in newborns that can lead to blindness, particularly if the infection is caused by Neisseria gonorrhoeae. Antiseptic or antibiotic medication is dispensed into the eyes of newborns, or dispensed systemically, soon after delivery to prevent neonatal conjunctivitis and potential vision impairment. OBJECTIVES: 1. To determine if any type of systemic or topical eye medication is better than placebo or no prophylaxis in preventing ophthalmia neonatorum. 2. To determine if any one systemic or topical eye medication is better than any other medication in preventing ophthalmia neonatorum. SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase, LILACS, and three trials registers, date of last search 4 October 2019. We also searched references of included studies and contacted pharmaceutical companies.  SELECTION CRITERIA: We included randomised and quasi-randomised controlled trials of any topical, systemic, or combination medical interventions used to prevent ophthalmia neonatorum in newborns compared with placebo, no prophylaxis, or with each other. DATA COLLECTION AND ANALYSIS: We used standard methods expected by Cochrane. Outcomes were: blindness or any adverse visual outcome at 12 months, conjunctivitis at 1 month (gonococcal (GC), chlamydial (CC), bacterial (BC), any aetiology (ACAE), or unknown aetiology (CUE)), and adverse effects.  MAIN RESULTS: We included 30 trials with a total of 79,198 neonates. Eighteen studies were conducted in high-income settings (the USA, Europe, Israel, Canada), and 12 were conducted in low- and middle-income settings (Africa, Iran, China, Indonesia, Mexico). Fifteen of the 30 studies were quasi-randomised. We judged every study to be at high risk of bias in at least one domain. Ten studies included a comparison arm with no prophylaxis. There were 14 different prophylactic regimens and 12 different medications in the 30 included studies. Any prophylaxis compared to no prophylaxis  Unless otherwise indicated, the following evidence comes from studies assessing one or more of the following interventions: tetracycline 1%, erythromycin 0.5%, povidone-iodine 2.5%, silver nitrate 1%. None of the studies reported data on the primary outcomes: blindness or any adverse visual outcome at any time point. There was only very low-certainty evidence on the risk of GC with prophylaxis (4/5340 newborns) compared to no prophylaxis (5/2889) at one month (risk ratio (RR) 0.79, 95% confidence interval (CI) 0.24 to 2.65, 3 studies). Low-certainty evidence suggested there may be little or no difference in effect on CC (RR 0.96, 95% CI 0.57 to 1.61, 4874 newborns, 2 studies) and BC (RR 0.84, 95% CI 0.37 to 1.93, 3685 newborns, 2 studies). Moderate-certainty evidence suggested a probable reduction in risk of ACAE at one month (RR 0.65, 95% 0.54 to 0.78, 9666 newborns, 8 studies assessing tetracycline 1%, erythromycin 0.5%, povidone-iodine 2.5%, silver nitrate 1%, colostrum, bacitracin-phenacaine ointment). There was only very low-certainty evidence on CUE  (RR 1.75, 95% CI 0.37 to 8.28, 330 newborns, 1 study). Very low-certainty evidence on adverse effects suggested no increased nasolacrimal duct obstruction (RR 0.93, 95% CI 0.68 to 1.28, 404 newborns, 1 study of erythromycin 0.5% and silver nitrate 1%) and no increased keratitis (single study of 40 newborns assessing silver nitrate 1% with no events).    Any prophylaxis compared to another prophylaxis Overall, evidence comparing different interventions did not suggest any consistently superior intervention. However, most of this evidence was of low-certainty and was extremely limited. AUTHORS' CONCLUSIONS: There are no data on whether prophylaxis for ophthalmia neonatorum prevents serious outcomes such as blindness or any adverse visual outcome. Moderate-certainty evidence suggests that the use of prophylaxis may lead to a reduction in the incidence of ACAE in newborns but the evidence for effect on GC, CC or BC was less certain. Comparison of individual interventions did not suggest any consistently superior intervention, but data were limited. A trial comparing tetracycline, povidone-iodine (single administration), and chloramphenicol for GC and CC could potentially provide the community with an effective, universally applicable prophylaxis against ophthalmia neonatorum.


Assuntos
Anti-Infecciosos/administração & dosagem , Oftalmia Neonatal/prevenção & controle , Viés , Cegueira/prevenção & controle , Eritromicina/administração & dosagem , Humanos , Recém-Nascido , Povidona-Iodo/administração & dosagem , Ensaios Clínicos Controlados Aleatórios como Assunto , Nitrato de Prata/administração & dosagem , Tetraciclina/administração & dosagem , Tracoma/prevenção & controle , Transtornos da Visão/prevenção & controle
2.
Zhonghua Yan Ke Za Zhi ; 56(8): 561-566, 2020 Aug 11.
Artigo em Chinês | MEDLINE | ID: mdl-32847332

RESUMO

Prevention of blindness is of paramount importance for eye care and health care in China. In the past 70 years, we have embraced a lot of advancements in practice, manpower and landmark studies for the prevention of blindness and development of ophthalmic epidemiology. This summary is dedicated to our predecessors and successors for their contributions to the progress of ophthalmology in China, particularly workers in the field of prevention of blindness and ophthalmic epidemiology. Congratulations on the 70th anniversary of Chinese Journal of Ophthalmology. (Chin J Ophthalmol, 2020, 56: 561-566).


Assuntos
Cegueira/prevenção & controle , Oftalmologia , Grupo com Ancestrais do Continente Asiático , China/epidemiologia , Olho , Humanos
3.
Adv Gerontol ; 33(2): 339-345, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32593250

RESUMO

There are about 1,3 billion people worldwide with visual disorders such as cataract and glaucoma, the prevalence of which is significantly higher in elder persons. Eye diseases remain a global medical, social and economic problem, associated with both the progression of the disease up to blindness and the lack of pathogenetic therapy methods. Timely detection of pathology is secondary prevention of glaucoma. At present, a number of diagnostic techniques have been developed, including mainly instrumental techniques. Undoubtedly, laboratory indicators should be used as screening methods of early diagnosis. Today, a group of biomarkers with different degrees of sensitivity and specificity has been identified. However, these markers have some difficulty in indicating. Finding signs of glaucoma in complete blood count is an important task. Glaucoma is recognized as a systemic disease, which should be reflected in the change in morphofunctional properties of blood elements.


Assuntos
Glaucoma/diagnóstico , Glaucoma/prevenção & controle , Qualidade de Vida , Idoso , Cegueira/etiologia , Cegueira/prevenção & controle , Diagnóstico Precoce , Glaucoma/complicações , Humanos , Pessoa de Meia-Idade
4.
PLoS One ; 15(4): e0227240, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32298265

RESUMO

This study examined and compared outcomes of deep learning (DL) in identifying swept-source optical coherence tomography (OCT) images without myopic macular lesions [i.e., no high myopia (nHM) vs. high myopia (HM)], and OCT images with myopic macular lesions [e.g., myopic choroidal neovascularization (mCNV) and retinoschisis (RS)]. A total of 910 SS-OCT images were included in the study as follows and analyzed by k-fold cross-validation (k = 5) using DL's renowned model, Visual Geometry Group-16: nHM, 146 images; HM, 531 images; mCNV, 122 images; and RS, 111 images (n = 910). The binary classification of OCT images with or without myopic macular lesions; the binary classification of HM images and images with myopic macular lesions (i.e., mCNV and RS images); and the ternary classification of HM, mCNV, and RS images were examined. Additionally, sensitivity, specificity, and the area under the curve (AUC) for the binary classifications as well as the correct answer rate for ternary classification were examined. The classification results of OCT images with or without myopic macular lesions were as follows: AUC, 0.970; sensitivity, 90.6%; specificity, 94.2%. The classification results of HM images and images with myopic macular lesions were as follows: AUC, 1.000; sensitivity, 100.0%; specificity, 100.0%. The correct answer rate in the ternary classification of HM images, mCNV images, and RS images were as follows: HM images, 96.5%; mCNV images, 77.9%; and RS, 67.6% with mean, 88.9%.Using noninvasive, easy-to-obtain swept-source OCT images, the DL model was able to classify OCT images without myopic macular lesions and OCT images with myopic macular lesions such as mCNV and RS with high accuracy. The study results suggest the possibility of conducting highly accurate screening of ocular diseases using artificial intelligence, which may improve the prevention of blindness and reduce workloads for ophthalmologists.


Assuntos
Neovascularização de Coroide/diagnóstico , Aprendizado Profundo , Interpretação de Imagem Assistida por Computador/métodos , Miopia/diagnóstico , Retinosquise/diagnóstico , Adulto , Idoso , Cegueira/prevenção & controle , Corioide/diagnóstico por imagem , Neovascularização de Coroide/complicações , Conjuntos de Dados como Assunto , Diagnóstico Diferencial , Feminino , Humanos , Macula Lutea/diagnóstico por imagem , Masculino , Programas de Rastreamento/métodos , Pessoa de Meia-Idade , Miopia/etiologia , Curva ROC , Retinosquise/complicações , Índice de Gravidade de Doença , Tomografia de Coerência Óptica
5.
Sci China Life Sci ; 63(9): 1-10, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32201927

RESUMO

Optic neuropathies lead to blindness; the common pathology is the degeneration of axons of the retinal ganglion cells. In this study, we used a rat model of retinal ischemia-reperfusion and a one-time intravitreal brain-derived neurotrophic factor (BDNF) injection; then we examined axon transportation function, continuity, physical presence of axons in different part of the optic nerve, and the expression level of proteins involved in axon transportation. We found that in the disease model, axon transportation was the most severely affected, followed by axon continuity, then the number of axons in the distal and proximal optic nerve. BDNF treatment relieved all reductions and significantly restored function. The molecular changes were more minor, probably due to massive gliosis of the optic nerve, so interpretation of protein expression data should be done with some caution. The process in this acute model resembles a fast-forward of changes in the chronic model of glaucoma. Therefore, impairment in axon transportation appears to be a common early process underlying different optic neuropathies. This research on effective intervention can be used to develop interventions for all optic neuropathies targeting axon transportation.


Assuntos
Transporte Axonal/efeitos dos fármacos , Axônios/efeitos dos fármacos , Fator Neurotrófico Derivado do Encéfalo/metabolismo , Pressão Intraocular/efeitos dos fármacos , Animais , Escala de Avaliação Comportamental , Cegueira/prevenção & controle , Fator Neurotrófico Derivado do Encéfalo/administração & dosagem , Modelos Animais de Doenças , Glaucoma/metabolismo , Injeções Intraoculares , Masculino , Nervo Óptico/metabolismo , Ratos Sprague-Dawley , Retina/metabolismo , Células Ganglionares da Retina/metabolismo
6.
Sci Rep ; 10(1): 2990, 2020 02 19.
Artigo em Inglês | MEDLINE | ID: mdl-32076076

RESUMO

Photoreceptor cell death is the ultimate cause of vision loss in many retinal disorders, and there is an unmet need for neuroprotective modalities to improve photoreceptor survival. Similar to cancer cells, photoreceptors maintain pyruvate kinase muscle isoform 2 (PKM2) expression, which is a critical regulator in aerobic glycolysis. Unlike PKM1, which has constitutively high catalytic activity, PKM2 is under complex regulation. Recently, we demonstrated that genetically reprogramming photoreceptor metabolism via PKM2-to-PKM1 substitution is a promising neuroprotective strategy. Here, we explored the neuroprotective effects of pharmacologically activating PKM2 via ML-265, a small molecule activator of PKM2, during acute outer retinal stress. We found that ML-265 increased PKM2 activity in 661 W cells and in vivo in rat eyes without affecting the expression of genes involved in glucose metabolism. ML-265 treatment did, however, alter metabolic intermediates of glucose metabolism and those necessary for biosynthesis in cultured cells. Long-term exposure to ML-265 did not result in decreased photoreceptor function or survival under baseline conditions. Notably, though, ML-265-treatment did reduce entrance into the apoptotic cascade in in vitro and in vivo models of outer retinal stress. These data suggest that reprogramming metabolism via activation of PKM2 is a novel, and promising, therapeutic strategy for photoreceptor neuroprotection.


Assuntos
Apoptose/efeitos dos fármacos , Ativadores de Enzimas/farmacologia , Células Fotorreceptoras/efeitos dos fármacos , Piruvato Quinase/metabolismo , Doenças Retinianas/tratamento farmacológico , Animais , Cegueira/etiologia , Cegueira/prevenção & controle , Linhagem Celular , Modelos Animais de Doenças , Ativadores de Enzimas/uso terapêutico , Glicólise/efeitos dos fármacos , Humanos , Injeções Intravítreas , Masculino , Camundongos , Camundongos Knockout , Células Fotorreceptoras/patologia , Isoformas de Proteínas/agonistas , Isoformas de Proteínas/metabolismo , Piruvato Quinase/genética , Coelhos , Ratos , Doenças Retinianas/complicações , Doenças Retinianas/patologia
7.
Ophthalmology ; 127(5): 608-615, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-31932092

RESUMO

PURPOSE: Both ranibizumab and aflibercept improved vision and decreased macular thickness in eyes with diabetic macular edema (DME) in clinical trials. This study compared the 12-month treatment outcomes of each drug in routine clinical practice. DESIGN: Retrospective analysis of data from the prospectively designed observational Fight Retinal Blindness! registry. PARTICIPANTS: Treatment-naive eyes tracked in the registry that initiated treatment with either ranibizumab (0.5 mg) or aflibercept (2 mg) for DME from December 1, 2013, through June 1, 2018. METHODS: Visual acuity (VA) was analyzed at 12 months in all eyes (completers, noncompleters, and eyes that switched treatment). MAIN OUTCOME MEASURES: The primary outcome was the mean change in VA from baseline to 12 months. RESULTS: We identified 383 eyes (ranibizumab, n = 166 eyes; aflibercept, n = 217 eyes) of 291 patients. Eyes receiving aflibercept showed a lower mean VA (mean difference, -3.1 letters) and a thicker maculae (mean difference, +26 µm) at baseline than those receiving ranibizumab, which were not significantly different. Patients receiving ranibizumab were older (mean difference, +2.7 years). The adjusted mean difference in VA change and central subfield thickness (CST) reduction were, respectively, +1 letter (1.4 letters for aflibercept vs. 0.4 letter for ranibizumab; P = 0.4) and -30 µm (-85 vs. -55 µm; P < 0.01) in eyes with initial VA of 20/40 or better and +3 letters (10.6 vs. 7.6 letters; P < 0.01) and -46 µm (-148 vs. -102 µm; P < 0.02) in those with VA of 20/50 or worse. Eyes in the aflibercept group received more median injections over 12 months than the ranibizumab group although this difference was not significant (8 vs. 6 injections; P = 0.13). Treatment switches, albeit low, were more frequent from ranibizumab to aflibercept than vice versa. Significantly more eyes in the aflibercept group were lost to follow-up within 12 months (21% vs. 9% ranibizumab; P < 0.01). CONCLUSIONS: Both drugs were beneficial for DME. Aflibercept-treated eyes, which had borderline worse vision and thicker maculae at baseline, showed larger CST reductions after 12 months of treatment. Larger VA gains were observed with aflibercept treatment when the initial VA was 20/50 or worse.


Assuntos
Inibidores da Angiogênese/uso terapêutico , Retinopatia Diabética/tratamento farmacológico , Edema Macular/tratamento farmacológico , Ranibizumab/uso terapêutico , Receptores de Fatores de Crescimento do Endotélio Vascular/uso terapêutico , Proteínas Recombinantes de Fusão/uso terapêutico , Idoso , Cegueira/prevenção & controle , Retinopatia Diabética/diagnóstico , Retinopatia Diabética/fisiopatologia , Feminino , Humanos , Injeções Intravítreas , Edema Macular/diagnóstico , Edema Macular/fisiopatologia , Masculino , Pessoa de Meia-Idade , Sistema de Registros , Retina/patologia , Estudos Retrospectivos , Tomografia de Coerência Óptica , Resultado do Tratamento , Fator A de Crescimento do Endotélio Vascular/antagonistas & inibidores , Acuidade Visual/fisiologia
8.
Curr Opin Ophthalmol ; 31(2): 81-84, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31904597

RESUMO

PURPOSE OF REVIEW: To describe the VISION 2020: The Right to Sight, global initiative for the elimination of avoidable blindness, the contribution of glaucoma to the magnitude of global blindness and priorities going forward. RECENT FINDINGS: Although the target of the World Health Organization's Global Action Plan (2014-2019) has not been met in terms of 25% reduction in avoidable blindness, there is evidence that the contribution of glaucoma to blindness and vision impairment is reducing. Yet this focus on a threshold of visual acuity by which to measure prevalence underestimates the true burden of glaucoma. Recent population-based studies demonstrate the scale of the unmet need. SUMMARY: Scaling up of integrated people-centered eye care, by embedding glaucoma detection and care pathways in health systems with a strong focus on primary healthcare, is necessary. Solutions include reinforcing existing pathways while emphasizing high-quality glaucoma care, in addition to novel solutions such as self-testing, digital portable technology, artificial intelligence, and multilevel care pathways that extend to the most underserved parts of the global community.


Assuntos
Cegueira/prevenção & controle , Oftalmopatias/prevenção & controle , Visão Ocular/fisiologia , Cegueira/epidemiologia , Oftalmopatias/epidemiologia , Saúde Global , Humanos , Agências Internacionais , Prevalência , Acuidade Visual
9.
Arch Dis Child Fetal Neonatal Ed ; 105(3): 328-330, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-30926715

RESUMO

The International Liaison Committee on Resuscitation uses the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) working group method to evaluate the quality of evidence and the strength of treatment recommendations. This method requires guideline developers to use a numerical rating of the importance of each specified outcome. There are currently no uniform reporting guidelines or outcome measures for neonatal resuscitation science. We describe consensus outcome ratings from a survey of 64 neonatal resuscitation guideline developers representing seven international resuscitation councils. Among 25 specified outcomes, 10 were considered critical for decision-making. The five most critically rated outcomes were death, moderate-severe neurodevelopmental impairment, blindness, cerebral palsy and deafness. These data inform outcome rankings for systematic reviews of neonatal resuscitation science and international guideline development using the GRADE methodology.


Assuntos
Tomada de Decisão Clínica , Guias de Prática Clínica como Assunto/normas , Ressuscitação/normas , Cegueira/prevenção & controle , Paralisia Cerebral/prevenção & controle , Consenso , Surdez/prevenção & controle , Humanos , Recém-Nascido , Internacionalidade , Transtornos do Neurodesenvolvimento/prevenção & controle , Morte Perinatal/prevenção & controle
11.
Asia Pac J Ophthalmol (Phila) ; 8(6): 424-428, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31789642

RESUMO

The actual numbers of people blind or with poor vision continue to increase despite so excellent progress that is being made in reducing the prevalence or percentage of people affected. More attention is required to provide quality outcomes for cataract surgery, prevent and manage myopia, detect and treat diabetic retinopathy, glaucoma, and age-related macular degeneration (AMD). Although more ophthalmologists are needed to provide this eye care, it is important that ophthalmologists work in effective teams with allied eye health personal to be able to meet the community needs.


Assuntos
Cegueira/prevenção & controle , Oftalmopatias/complicações , Oftalmologia/organização & administração , Cegueira/epidemiologia , Oftalmopatias/terapia , Humanos , Oftalmologia/tendências , Prevalência
12.
Asia Pac J Ophthalmol (Phila) ; 8(6): 448-456, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31789647

RESUMO

Diabetic retinopathy (DR), a major cause of blindness in working-age adults, is emerging as a major public health issue worldwide, in particular in low- and middle-income countries (LMIC). Traditionally, the management of DR has been on tertiary-level treatment (eg, laser, anti-VEGF injections and surgery) in specialized settings by highly trained ophthalmologists on individual patients. To win the war on DR, a paradigm shift in strategic focus and resources must be made from such tertiary treatment toward primary and secondary prevention, which are broader, more impactful, and cost-effective for the larger population. These include improving education and awareness of risk of DR among people initially diagnosed with diabetes, promoting behavioral modifications such as physical activity and medication adherence for improving glycemic and blood pressure control, setting up systematic screening programs for DR to detect the onset or progression of the disease, and implementing cost-effective, evidence-based policies and guidelines for managing DR. Additionally, there is a need to leverage on novel technology including the application of digital big data to predict people at risk of diabetes and DR, the use of wearable devices and smart phone apps, behavioral techniques including social media for self-management of diabetes, and telemedicine-based DR screening incorporating artificial intelligence (AI) to broaden access to screening in all settings. To turn the tide on the war on DR, we must reframe DR not only as a specific condition that can be managed by ophthalmologists, but fundamentally, as a preventable condition by shifting the weight of strategies from tertiary to secondary and primary battlegrounds.


Assuntos
Retinopatia Diabética/prevenção & controle , Cegueira/prevenção & controle , Retinopatia Diabética/diagnóstico , Medicina Baseada em Evidências/normas , Humanos , Programas de Rastreamento/métodos , Educação de Pacientes como Assunto/organização & administração , Atenção Primária à Saúde/normas , Telemedicina/organização & administração
13.
Asia Pac J Ophthalmol (Phila) ; 8(6): 481-488, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31789651

RESUMO

PURPOSE: We examined patients presenting in a tertiary eye hospital in Nepal, focusing on information relevant to screening and management programs for vitreo-retinal (VR) disease. DESIGN: Retrospective, cross-sectional study. METHODS: We reviewed all patients presenting for the first time to the VR-clinic over 1 year. We quantified patient demography, symptoms and duration, systemic diseases, ophthalmological examinations, diagnostic investigations, and final diagnoses. RESULTS: Of the 1905 cases, 1148 were male (60.3%). The 25th percentile of ages was 29 and 38 years for male and female, respectively; thus, female presented later (P < 0.0001). Hypertension was the commonest systemic disease (40.8%), followed by diabetes (32.5%). Age-related macular degeneration (AMD) and diabetic retinopathy (DR) affected 447 eyes (11.8%) and 416 eyes (10.9%), respectively. Male and female AMD and DR patients did not differ in age or disease duration. Similarly, age or disease duration for DR did not correlate with severity. Asymmetry of disease severity between eyes with AMD and DR was largest in patients with 1 normal eye. Presenting acuity was asymmetric between eyes (P < 0.0001) with people more often reporting once their right eyes had acuity of 6/18 or worse. CONCLUSIONS: The screening of blood pressure and glucose levels combined with fundus photography could prevent many from progressing to life-changing visual impairment and blindness. Later reporting by females began at childbearing age; therefore, education and ocular screening could be usefully coupled in reproductive health programs. Clubbing VR disease screening with other established health programs like diabetes control program, hypertension clinics, school health program, and so on, would provide economical and sustainable approach.


Assuntos
Doenças Retinianas , Adulto , Idoso , Cegueira/etiologia , Cegueira/prevenção & controle , Glicemia/análise , Pressão Sanguínea/fisiologia , Estudos Transversais , Complicações do Diabetes , Feminino , Humanos , Hipertensão/complicações , Masculino , Pessoa de Meia-Idade , Nepal , Doenças Retinianas/complicações , Doenças Retinianas/diagnóstico , Doenças Retinianas/fisiopatologia , Estudos Retrospectivos , Acuidade Visual/fisiologia
14.
RMD Open ; 5(2): e001003, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31673411

RESUMO

Objectives: To analyse the current evidence for the management of large vessel vasculitis (LVV) to inform the 2018 update of the EULAR recommendations. Methods: Two systematic literature reviews (SLRs) dealing with diagnosis/monitoring and treatment strategies for LVV, respectively, were performed. Medline, Embase and Cochrane databases were searched from inception to 31 December 2017. Evidence on imaging was excluded as recently published in dedicated EULAR recommendations. This paper focuses on the data relevant to giant cell arteritis (GCA). Results: We identified 287 eligible articles (122 studies focused on diagnosis/monitoring, 165 on treatment). The implementation of a fast-track approach to diagnosis significantly lowers the risk of permanent visual loss compared with historical cohorts (level of evidence, LoE 2b). Reliable diagnostic or prognostic biomarkers for GCA are still not available (LoE 3b).The SLR confirms the efficacy of prompt initiation of glucocorticoids (GC). There is no high-quality evidence on the most appropriate starting dose, route of administration, tapering and duration of GC (LoE 4). Patients with GCA are at increased risk of dose-dependent GC-related adverse events (LoE 3b). The addition of methotrexate or tocilizumab reduces relapse rates and GC requirements (LoE 1b). There is no consistent evidence that initiating antiplatelet agents at diagnosis would prevent future ischaemic events (LoE 2a). There is little evidence to guide monitoring of patients with GCA. Conclusions: Results from two SLRs identified novel evidence on the management of GCA to guide the 2018 update of the EULAR recommendations on the management of LVV.


Assuntos
Cegueira/prevenção & controle , Arterite de Células Gigantes/complicações , Arterite de Células Gigantes/tratamento farmacológico , Arterite de Takayasu/tratamento farmacológico , Anticorpos Monoclonais Humanizados/administração & dosagem , Anticorpos Monoclonais Humanizados/uso terapêutico , Antirreumáticos/administração & dosagem , Antirreumáticos/uso terapêutico , Biomarcadores/metabolismo , Quimioterapia Combinada , Feminino , Arterite de Células Gigantes/diagnóstico , Arterite de Células Gigantes/metabolismo , Glucocorticoides/administração & dosagem , Glucocorticoides/uso terapêutico , Humanos , Masculino , Metotrexato/administração & dosagem , Metotrexato/uso terapêutico , Estudos Observacionais como Assunto , Avaliação de Resultados em Cuidados de Saúde , Ensaios Clínicos Controlados Aleatórios como Assunto , Recidiva , Gestão de Riscos , Vasculite Sistêmica/patologia , Arterite de Takayasu/complicações
16.
Facial Plast Surg Clin North Am ; 27(4): 557-564, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31587773

RESUMO

Soft tissue fillers continue to gain popularity in addressing volume loss and changes associated with facial aging. The rare but devastating complication from iatrogenic vascular occlusion can result in irreversible vision loss. This article discusses the complications of vision loss associated with fillers and reviews applicable treatment techniques and prevention methods.


Assuntos
Cegueira/induzido quimicamente , Cegueira/prevenção & controle , Técnicas Cosméticas/efeitos adversos , Preenchedores Dérmicos/efeitos adversos , Olho/irrigação sanguínea , Face/irrigação sanguínea , Isquemia/induzido quimicamente , Cegueira/diagnóstico , Cegueira/terapia , Vasos Sanguíneos/anatomia & histologia , Humanos , Oftalmologia , Encaminhamento e Consulta , Oclusão da Artéria Retiniana/induzido quimicamente
17.
Middle East Afr J Ophthalmol ; 26(2): 83-88, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31543665

RESUMO

PURPOSE: The purpose of this study is to describe the methodology and to assess the effectiveness of a community-based rehabilitation (CBR) program to identify and refer children with blinding cataract for the management and surgery to reduce the burden of childhood blindness due to cataract in Kinshasa. METHODS: Church-based volunteers were trained to identify children with presumed eye disorders in their localities and households and to refer them for cataract identification by an ophthalmic nurse during parishes' visits. Volunteers were parishioners living in the quartiers where identification took place and worked as community workers with the CBR program. Nurses used a lamp-torch to rule out cataract. Selected children were referred to the tertiary eye health facility at St Joseph Hospital for diagnosis and management. RESULTS: Identification took place in 31 out of 165 parishes in the Archdioceses of Kinshasa from 2000 to 2016 and 11,106 children aged <16 years were screened. Among them, 1277 children (11.5%) were presumed to have cataract. Ninety-two children among them died before surgery; 107 children were lost to further follow-up and did not report to the CBR center for referral. Reasons given were change of home address, moving in their lieu of origin, death, and refusal of treatment by the parents. Finally, only 1078 children were referred to the pediatric ophthalmologist and 705 children (65.4%) were definitively diagnosed to have treatable cataract, while in 373 children (34.6%), cataract surgery was not indicated for several reasons. There was a positive history of familial cataract in 36 children (2.8%). CONCLUSION: Using church-based volunteers and ophthalmic nurses during community screening proved efficient in the identification and referral of pediatric cataract. Keeping regular identification activities in the community and maintaining high-quality and accessible pediatric cataract surgery services can help to clear up the backlog of cataract blind children.


Assuntos
Extração de Catarata , Catarata/diagnóstico , Serviços de Saúde Comunitária/organização & administração , Organizações Religiosas/organização & administração , Encaminhamento e Consulta/organização & administração , Adolescente , Cegueira/prevenção & controle , Catarata/terapia , Criança , Pré-Escolar , Estudos Transversais , República Democrática do Congo , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pediatria , Voluntários
18.
Int J Pediatr Otorhinolaryngol ; 126: 109615, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31416016

RESUMO

Duane's Retraction Syndrome (DRS), a congenital cranial dysinnervation disorder, accounts for 5% of all strabismus. A vascular anomaly in DRS, which became clinically relevant in the context of significant epistaxis, is presented. A 15-year-old girl with DRS underwent a rhinological procedure for traumatic nasal deformity and suffered large volume epistaxis. Using angiography, an anatomical variation was identified, noting the ophthalmic artery was supplied by branches from the sphenopalatine artery, facial artery, and middle meningeal artery; not from the internal carotid artery. Hence epistaxis control was achieved via alternative methods, and unilateral blindness was avoided.


Assuntos
Cegueira/prevenção & controle , Síndrome da Retração Ocular/complicações , Embolização Terapêutica/métodos , Epistaxe/terapia , Obstrução Nasal/cirurgia , Artéria Oftálmica/anormalidades , Complicações Cognitivas Pós-Operatórias/terapia , Adolescente , Angiografia , Artéria Carótida Interna/diagnóstico por imagem , Epistaxe/etiologia , Feminino , Humanos , Obstrução Nasal/complicações , Artéria Oftálmica/diagnóstico por imagem , Rinoplastia/efeitos adversos , Estrabismo/etiologia
19.
BMC Health Serv Res ; 19(1): 549, 2019 Aug 05.
Artigo em Inglês | MEDLINE | ID: mdl-31382956

RESUMO

BACKGROUND: The awareness of diabetes mellitus (DM) and its complications, especially diabetic retinopathy (DR), is the key to reducing their burden. This study aimed to assess both the awareness of diabetic outpatients and their action towards periodic eye exam, and to determine the causes of non-compliance amongst patients who were aware. Because the Syrian Crisis affected all aspects of Syrians' life, the study aimed to determine the crisis' effects on patients' care-seeking behavior. Our study was the first step in paving the way of prevention strategies. METHODS: This observational cross-section study was conducted on 260 patients with DM who were visiting the four main hospitals in the Syrian capital, Damascus between August and November 2017. RESULTS: The mean (±SD) age of participants was 54.3(±12.8) years. Females were more than half (56.2%). The majority were from areas outside Damascus (72.3%). The mean (±SD) DM duration was 10.6 (±7.1) years. Almost all patients (93.8%) thought that DM could affect the eye. 67.3% believed that it could cause blindness. 86.9% of the patients conceived that DM patients should visit an ophthalmologist regularly. 37% did not visit any ophthalmologists at all, while 63% reported they had visited their ophthalmologists. Only 21.5% had a regular eye exam. Gender, educational level, economic status, province, and family history of DM had statistically an insignificant relation with an ophthalmologist visit. The preponderance of the patients who haven't visited regularly did not appreciate the necessity of regular eye exam. Diabetic neuropathy was the most common complication of DM that patients were aware of (92%) and suffered from (56.5%). Meanwhile, regarding the effects of the Syrian Crisis: 41.2% of diabetic patients had stopped their medications for at least one month, mainly because the drugs were unavailable (74.7% of them), as some drug companies had been destroyed. Half of the patients had struggled to reach a medical care center. Half of the patients had been displaced, two-third of them were from outside Damascus. CONCLUSION: A screening program for DR should be initiated. Also, awareness about DM and its complications, especially DR, should be raised through doctors and media.


Assuntos
Retinopatia Diabética/prevenção & controle , Conhecimentos, Atitudes e Prática em Saúde , Adulto , Idoso , Assistência Ambulatorial , Conflitos Armados , Conscientização , Cegueira/prevenção & controle , Estudos Transversais , Neuropatias Diabéticas/diagnóstico , Neuropatias Diabéticas/epidemiologia , Neuropatias Diabéticas/psicologia , Retinopatia Diabética/diagnóstico , Retinopatia Diabética/epidemiologia , Diagnóstico Precoce , Feminino , Hospitais Públicos/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Pacientes Ambulatoriais/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Cooperação do Paciente/psicologia , Cooperação do Paciente/estatística & dados numéricos , Fatores Socioeconômicos , Síria/epidemiologia
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